False teeth need to be taken out before a general anaesthetic, doctors warn in the journal BMJ Case Reports after a 72 year old’s dentures got stuck in his throat during surgery to remove a harmless lump in his abdominal wall, and weren’t discovered for eight days. Aside from experiencing considerable pain, bleeding; and swallowing difficulties, the oversight led to repeated hospital visits, additional invasive tests, blood transfusions; and eventually more surgery for the man.

A general anaesthetic

The doctors describe how six days after abdominal surgery; the man turned up at A&E complaining of blood in the mouth and swallowing difficulties and pain, which had prevented him from eating solid food ever since. Nothing in his test results prompted doctors to consider anything other than a respiratory infection and the side effects of having had a tube down his throat during his operation. He is therefore prescribe mouthwash; antibiotics and steroids; and sent home.

Two days later he returned with worsening symptoms. He had been unable to; swallow any of the medicine he had been prescribe. He was admit to hospital with suspect aspiration pneumonia a severe chest infection usually cause by inhaling food or stomach acid or saliva into the lungs. During this hospital stay; a diagnostic procedure to look at his throat and voice box revealed a semi-circular object lying across his vocal cords; which had clearly caused internal swelling and blistering.

Suspected aspiration pneumonia

When this is explain to him, the man revealed that his dentures; which consist of a metal roof plate and three false teeth; had been lost during his previous; hospital stay. He then had emergency surgery to remove the dentures and is discharge after six days. But six days later a bout of bleeding prompted his return. As tests reveal the bleeding had stop; he is sent home; only to reappear 10 days later with the same problem.

After a couple of days he is again discharge, but return six days later because of further bleeding. Tests reveal that he had internal wound tissue around the site of the blistering which is cauteris to prevent further bleeding. Because he had lost so much blood, he also required a blood transfusion. He is discharge after two days; but return again nine days later with further bleeding, which require emergency surgery as the source of the bleed was a torn artery in the wound.

During bag-mask ventilation

A check-up a week after this procedure shows that the tissue was healing well; and six weeks later he had not needed further emergency care and his blood count was back to normal. The authors note that this isn’t the first document case of dentures being inhale while anaesthetic is being infuse. “There are no set national guidelines on how dentures should be managed during anaesthesia, but it is known that leaving dentures in during bag-mask ventilation allows for a better seal during induction [when the anaesthetic is being infused]; and therefore many hospitals allow dentures to be removed immediately before intubation [when a tube is inserted into the airway to assist breathing];” write the authors.