Endodontic Files and Guts.

Iatrogenic September 28th, 2006

I’m still cleaning out my desk drawer. Here is a sequence of films that shows a file that was swallowed and made its way out the other end. The dentist swears he was using a rubber dam and the file flipped over and under…




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  • Dr. Mommy, D.D.S.

    wow, both people were lucky there wasn’t a perforation. how the heck can something like that happen?

    i won’t do an endo without a rubber dam, but i know a lot of general dentists who do. actually, i refered a seemingly simple case to a specialist because the rubber dam made her “claustrophobic” and she couldn’t tolerate having it in her mouth. she probably could have tolerated the procedure itself without it, but that was just one place i didn’t want to go. i recommended nitrous oxide/IV sedation for her.

    oh, i’m trying your triazolam suggestion on another difficult freezing case. it’s an endo i’m in the middle of on a 36 with four canals, and he had the telltale signs of a successful and profound IA nerve block, but is still having extreme pain and jumps when i instrument in the apical 1/3 (i completed the pulpectomy (to the apex, i measured with the apex locator) about a week ago when he came to my office as an emergency. i sent him home without completing the case with the script. do you have any other suggestions?

  • Ameloblast

    In hard to numb cases, I usually end up giving PDL shots and then intracanal injections if the pt is still sensitive. This usually allows me to get to the apical third. If they are sensitive down there and I can’t get intrapulpals to work, I’ll medicate the canals and pack the patient up for another day.

    This does two things: Most intracanal medications will provide some reduction in inflammation and/or cause necrosis of residual pulp (I use calcium hydroxide) so that there won’t be as much vital tissue next time. Second, the extra appointment will give periodontal and pulpal tissues time to settle from the severe pulpitis, and thus be easier to numb.

    If I’m still worried about pain control by the second appt, I’ll consider nitrous, oral sedation, and/or a strong antiinflammatory and/or a narcotic an hour or so prior to the appointment. It’s rare, however, that I do anything more than have them take a Toradol or some Ibuprofen prior to that second appointment.

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