Ingestion of foreign body is commonly encountered in radiological practice and its significance should not be underestimated [1]. Whenever a dentist loses a dental material or any other foreign object inside oral cavity, a radiologist must be consulted even if the patient has no symptoms [4]. Usually, the foreign bodies pass through the GI tract and are evacuated in 2 to 5 days without symptoms [3]. The two most common locations of an ingested foreign object at the initial presentation is in the stomach (58.1%) and small intestine (32.7%) [5]. Endodontic files have been reported to pass through GI tract within 3 days, while 10-20% require endoscopic intervention and only in 1% surgery is necessary [6].
Radiographic examination with chest and abdominal x-ray is necessary for determining the location, size and nature of the ingested foreign object [7]. The computed tomography (CT) scan can also be used to localize foreign objects, but it is usually performed to define the exact extent of injury to the involved organs and the damage to the surrounding tissues [1]. In our case, the foreign body was radio opaque and the size assessment was noted. We did not perform a CT scan as the foreign body was identified in radiography and the patient had normal blood tests and no symptoms.
Size, sharpness and shape of the ingested foreign body are some characteristics that should be taken into consideration when a medical professional has to deal with this condition. The risk of injury increases when the size of the object is more than 5cm or has a pointed shape [8].
According to the literature, the removal of a foreign object that has entered the gastrointestinal tract is determined on the basis of patients’ age, size shape and location of the object, and time since the ingestion. The risk of complications such as obstruction or perforation determines the timing of endoscopy [9]. The overall rate of perforation caused by ingested foreign bodies is in the range of 1-7 %. However, the incidence is increased to 15-35%, when pointed or sharp foreign bodies are considered [10]. According to Bondarde P et al., the management of sharp bodies such as endodontic file, when lodged in GI tract, is endoscopic retrieval or the careful monitoring with periodic radiographs. If the foreign body does not succeed to progress after 72 hours or complications such as perforation, obstruction or bleeding are noticed, surgery should be preferred immediately [4]. In our case, periodic abdominal radiographies were performed for 7 days, because the patient did not agree to make any endoscopic or surgical intervention the first 7 days. Oral gastrografin was prescribed for allowing the rapid transport of the foreign body within the GI tract. The barium sulfate was not preferred to be used because of its side-effects such as constipation and mechanical obstruction of bowel, which can make it difficult to perform endoscopy [11]. In addition, laxative treatment should be given to patients after barium studies to reduce the incidence of colonic retention of barium sulfate [12]. Fortunately, the foreign body which was identified as a 2-cm-long dental bur was successfully removed by gastroenterologists endoscopically 8 days after the ingestion.

Conclusion

Iatrogenic accidents during routine dental procedures are common and unpredictable. Early recognition and diagnosis of this condition is the key to prevent serious complications. In 10-20% of these cases endoscopic intervention is necessary and less than 1% of patients require surgical retrieval. In our case the foreign body was removed by gastroenterologists endoscopically.