What is the course of action if a dental burr breaks in a patient's mouth?

Management of a Broken Dental Burr in Patient's Mouth

When a dental burr breaks in a patient's mouth, immediate retrieval of the fragment is essential to prevent aspiration, ingestion, or soft tissue injury, and the patient should be promptly referred to a dental professional if retrieval is not immediately successful.

Immediate Actions

1. Stop the procedure immediately

2. Assess the situation:

   • Determine if the patient has aspirated or swallowed the burr fragment
   • Check for signs of respiratory distress (primary concern)
   • Examine the oral cavity thoroughly to locate the fragment

3. If the fragment is visible in the mouth:

   • Carefully remove it using appropriate instruments (dental forceps/tweezers)
   • Avoid pushing the fragment further into soft tissues or toward the airway
   • Document the retrieval and examine the fragment to ensure it's complete

Emergency Management if Fragment Cannot Be Located

If Aspiration is Suspected:

• Signs include coughing, choking, respiratory distress
• Position patient upright or in a position that facilitates breathing
• Activate emergency medical services immediately 1
• Chest radiograph may be indicated if breathing difficulties are present to rule out aspiration 1

If Ingestion is Suspected:

• Signs include gagging, swallowing movements without respiratory distress
• Refer for immediate medical evaluation 2
• Radiographic examination (abdominal X-ray) to locate the fragment
• Endoscopic removal may be required as demonstrated in case reports 2

If Embedded in Soft Tissue:

• Carefully examine oral tissues for signs of the fragment
• Radiographic examination to locate the fragment precisely 3
• Unusual soft tissue reactions can occur if fragments remain embedded 4
• Refer to a dental professional for proper removal

Protocol for Dental Professionals

1. Accurate localization:

   • Obtain appropriate radiographs to determine exact location of the fragment 3
   • Consider CBCT if conventional radiographs are inconclusive

2. Retrieval strategy:

   • Plan surgical approach based on imaging findings
   • Ensure adequate anesthesia and visibility
   • Use magnification when necessary
   • Retrieve fragment as soon as possible to avoid complications 3

3. Post-retrieval management:

   • Verify complete removal through visual inspection and radiographs
   • Manage any tissue damage resulting from the fragment or retrieval process
   • Prescribe appropriate medications if indicated (antibiotics only if infection risk is high)

Prevention of Complications

• Monitor for signs of infection at the site where the burr fragment was located
• Follow up with the patient to ensure proper healing
• Document the incident thoroughly, including the type of burr, location found, and any treatment provided

Prevention Strategies for Future Cases

• Regularly inspect burrs for signs of wear or damage 3
• Monitor the number of uses for each burr
• Use light pressure with minimal lateral force during procedures 3
• Consider using protective devices (rubber dam) when appropriate
• Ensure proper maintenance of dental handpieces

Special Considerations

• In cases where fragments are embedded in bone or difficult to access areas, referral to an oral surgeon may be necessary 3
• If the fragment cannot be retrieved immediately and is not causing acute symptoms, close follow-up is essential to monitor for migration or complications
• For fragments embedded near vital structures (nerves, vessels), specialized imaging and surgical planning may be required

The management of a broken dental burr requires prompt action to prevent potentially serious complications such as aspiration, which could lead to significant morbidity or mortality. When in doubt about the location or appropriate management, immediate referral to emergency services or dental specialists is the safest approach 5.