
Dental Crown Aspiration Mimics Chronic Bronchitis
A 44-year-old man with a history of tobacco use experienced months of chronic cough and recurrent bronchitis, only to later discover that a dislodged dental crown was lodged in his bronchus. The case highlights the importance of vigilance during dental procedures and the role of imaging and bronchoscopy in diagnosing silent aspirations.
Foreign body aspiration in adults is rare and often overlooked, especially when it involves dental materials. Unlike in pediatric cases, aspiration in adults may present with subtle or nonspecific symptoms, delaying diagnosis and increasing the risk of complications. Dental crowns, small and radiopaque, represent a potential hazard during or after dental procedures.
In a case study published in Cureus, a 44-year-old male with a significant smoking history presented with persistent cough, mucopurulent sputum, recurrent episodes of bronchitis, and progressive weight loss over a 6-month period. Despite empirical antibiotic therapy, his symptoms failed to improve. Six months earlier, the patient had undergone crown placement without immediate complications.
On examination, pulmonary consolidation was noted in the right upper hemithorax. Intraoral findings included poor oral hygiene and extensive caries. Chest radiographs revealed lobar pneumonia with a calcified opacity in the right upper lobar bronchus. Computed tomography imaging confirmed parenchymal destruction distal to a calcified foreign body nearly occluding the bronchial lumen. Differential diagnoses initially included tuberculosis and malignancy due to the patient’s smoking history.
Flexible bronchoscopy revealed a foreign body at the bronchial entrance with smooth and irregular surfaces, consistent with a prosthetic crown. Attempts at removal were unsuccessful. Remarkably, the patient spontaneously expectorated the crown several days later during a coughing episode. Symptoms rapidly improved, with resolution of bronchitis and weight gain, coinciding with smoking cessation. However, irreversible parenchymal damage was evident, necessitating long-term surveillance to monitor for complications such as recurrent infections, aspergilloma, hemoptysis, or potential malignant transformation.
This case underscores several important considerations for oral health professionals. First, aspiration of dental materials, though rare, should remain a recognized risk during restorative and prosthetic procedures, especially in patients with poor dentition, supine positioning, or compromised protective reflexes. Preventive measures, such as rubber dam use, floss ligatures, and high-volume suction, reduce the likelihood of aspiration. Second, persistent respiratory symptoms following dental procedures warrant timely investigation with imaging and, when indicated, bronchoscopy to avoid delayed diagnosis. Third, interdisciplinary collaboration between dentistry, pulmonology, and radiology is crucial for patient safety and favorable outcomes.
Rigid bronchoscopy remains the gold standard for foreign body removal, though flexible bronchoscopy has diagnostic and therapeutic value in selected cases. Delayed intervention, as demonstrated here, increases the risk of pulmonary destruction. Ultimately, prevention remains the most effective strategy, requiring careful intraoperative protocols and patient education. Click here to read more.