Saturday, September 29, 2007

Inhaling Teeth

Sometime this week, Dad aspirated a portion of his dental hardware (4 fake teeth attached to his partial plate)into his right lung. He probably has no clear recollection of exactly when this happened although I'm curious to learn what he might remember. All I know is that Wednesday evening at dinner he asked that I arrange an appointment with his dentist because "my bridge isn't fitting well; it won't latch onto my teeth". He seemed to be eating ok and allowed that it wasn't "an emergency" and an appointment for next week would be fine.

Yesterday morning it was clear Dad was sick; Mom called early to say he was up and dressed all by himself, confused about what was going on, withdrawn, and non conversant. She asked me to stop by on my way to work. By the time I got to their apartment, the medics had been summoned by the staff who thought he perhaps had suffered a stroke. Not. The answer was clear from the chest Xray which was done in the ER an hour later; there, lighting up the right lower lobe bronchus was a strip of metal about an inch long, in the shape of 4 teeth!

Foreign body aspirations are fairly common in the very young. The classic case is the toddler who sucks a peanut  or coin into the lungs. We are taught in medical school that the foreign body almost always goes into the right lower lobe bronchus owing to the anatomy of the bronchial tree; the path is a direct shot down the trachea and into the rather steep take-off of the right lower lobe bronchus. It's all about the path of least resistance and gravity. In the elderly, there are plenty of cases of aspirated dental appliances but owing to the large size they can get hung up in less desirable places like the the vocal cords or trachea where they obstruct air flow. We should be grateful these teeth flew farther downstream. However, in the process of sitting there for who knows how long, Dad developed the predictable pneumonia beyond the blockage. The lungs don't appreciate the assault of all those oral bacteria. Is this too much information for you?

And so, I was once again impressed by the prompt and professional care he received from the colleagues that I work with regularly. It wasn't long before Dad, who was considerably better with a little supplemental oxygen, signed the consent for a bronchoscopy and ultimately had the teeth snared out of his lung and plopped in a plastic cup...."You'll want to take these to his dentist", the doctor said. Indeed.

What next? How can we ever know what adventures and misadventures are coming our way? These are times when things are predictably unpredictable for us all.

By the way, Dad said "ok" for me to share these films; a dramatic finding and classic radiographic finding.

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