Aspiration of foreign bodies in adults is significantly less common than in children and therefore often remains outside the focus of clinicians. Unlike acute pediatric cases, aspiration in adults can be asymptomatic or accompanied by nonspecific manifestations, leading to delayed diagnosis and the development of severe complications. Dental materials, including crowns, represent a special risk group due to their small size and radiopacity, which can allow them to remain in the airways for extended periods, mimicking chronic lung diseases.
In a clinical case published in the journal Cureus, a 44-year-old man with a long history of smoking was described as suffering from chronic cough, mucopurulent sputum production, recurrent episodes of bronchitis, and progressive weight loss over a six-month period. Despite repeated empirical antibiotic prescriptions, no clinical improvement was observed.
Six months prior to the onset of symptoms, the patient had a dental crown placed. The procedure was performed without apparent complications, and no episode of possible aspiration was recorded by either the patient or the doctor.
Physical examination revealed signs of consolidation in the upper lobes of the right lung. Oral examination showed poor hygiene and multiple carious lesions. Chest radiography revealed lobar pneumonia and a calcified formation in the lumen of the right upper lobe bronchus.
Computed tomography confirmed the presence of a dense foreign body almost completely occluding the bronchus, with significant destructive changes in the lung tissue distal to the obstruction. Considering the history of smoking and systemic symptoms, tuberculosis and malignant lung neoplasm were considered in the differential diagnosis.
During flexible bronchoscopy, a foreign body with smooth and irregular surfaces was discovered in the area of the bronchial orifice, morphologically consistent with an orthopedic dental crown. Attempts at endoscopic removal were unsuccessful.
Unexpectedly, a few days later, the patient spontaneously coughed up the crown during a coughing fit. Following this, rapid clinical improvement was observed: resolution of bronchitis symptoms, restoration of body weight, and overall improvement in well-being. An additional positive factor was the cessation of smoking.
Nevertheless, imaging studies confirmed irreversible damage to the lung parenchyma. The patient was placed under long-term monitoring due to the risk of developing chronic infections, hemoptysis, aspergilloma, and potential malignancy in the altered lung areas.
This clinical case highlights several fundamentally important aspects of dental practice. Firstly, aspiration of dental materials, although rare, remains a real threat during restorative and prosthetic procedures. The risk increases in patients with poor dental condition, when working in a supine position, and also when protective reflexes are diminished.
Secondly, aspiration prevention should be considered a mandatory safety standard. The use of a rubber dam, securing small prosthetic structures with dental floss, employing high-volume aspiration, and strict control of the operating field significantly reduce the likelihood of such complications.
The case also demonstrates the importance of vigilance among physicians of other specialties. Persistent respiratory symptoms following dental treatment require timely investigation using imaging methods and, if necessary, bronchoscopy. Delayed diagnosis, as illustrated in this observation, can lead to irreversible lung tissue damage.
Rigid bronchoscopy remains the “gold standard” for removing foreign bodies from the airways; however, flexible bronchoscopy plays an important role in diagnosis and in certain therapeutic situations. The key factor for a favorable outcome remains close collaboration between dentists, pulmonologists, and specialists in diagnostic imaging.
Aspiration of a dental crown can masquerade as chronic bronchitis or pneumonia and remain undetected for months. The presented case serves as a reminder that prevention, clinical vigilance, and interdisciplinary cooperation are fundamental to patient safety. For the dental community, this is yet another confirmation that even small details during treatment can have serious systemic consequences, and adherence to safety protocols is critically important for preserving patient health and life.
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