Patient swallows screwdriver, aspirates wrench

Florida dentists and their patients were puzzling this week over the case of a dentist who dropped both a screwdriver and a wrench -- in two separate appointments -- down the same patient's throat. The patient later died.

Standard precautions would have saved the 90-year-old patient's life, according to his daughter, who is suing the dentist, according to an Orlando Sentinel story.

The patient, Charles Gaal Jr., first went to Wesley Meyers, D.M.D., of Winter Park, FL, in September 2006 complaining that he was having some trouble with a set of lower dentures, according to a complaint filed with the Florida Department of Health. Dr. Meyers proposed a treatment plan to replace them with an implant-supported set of dentures.

Treatment began in October 2006. During a visit, Dr. Meyers dropped an implant screwdriver into the patient's throat. Gaal swallowed the object, which later had to be retrieved from his large intestine via a colonoscopy.

Despite the incident, Gaal wanted to continue treatment with Dr. Meyers, said Gaal's daughter Anne Marie Greer in the Orlando Sentinel story.

But during another visit in May 2007, Dr. Meyers dropped a miniwrench into the patient's throat. This time he unsuccessfully tried the Heimlich maneuver to dislodge the tool. An x-ray done later revealed that the patient had aspirated the miniwrench into his left lung, according to state documents.

Two emergency bronchoscopies were performed to remove the tool, but both were unsuccessful. More procedures followed and, even though the miniwrench was eventually removed, Gaal never regained his strength and died on June 19, 2007, from complications that included acute respiratory failure, pneumonia, and aspiration, according to his death certificate.

The complaint with the Florida Department of Health states that Dr. Meyers did not take necessary precautions while performing the implant procedures, failed to report the incidents to the state as required by law, and did not call 911 or engage in emergency protocol in both instances.

Dr. Meyers license was briefly suspended in January 2008. Last week the state fined him $17,000 and restricted from performing implant procedures until he completes further training. He will also reimburse all medical costs to Gaal's family, and has voluntarily agreed to practice only on patients who are 65 or younger.

Kim Gowey, D.D.S., past president of the American Academy of Implant Dentistry, said that such incidents are rare and that he has never heard of one that has been fatal.

However, he recommends some basic safety procedures to prevent such a tragedy.

Small implant instruments such as screwdrivers have little holes near the top, and dentists can put a piece of floss through them so they can be retrieved in case they fall down a patient's throat, Dr. Gowey explained.

For objects that cannot be tied to floss, placing a 4 x 4 piece of gauze on the tongue between the throat and the area being worked on is a good safety mechanism, he said.

Another precautionary measure is to have your patients sit upright, reducing the risk of anything falling down their throat.

"Having a patient lying flat on the back with an open throat is not a good idea," Dr. Gowey cautioned.

Finally, it is important to order an x-ray if you are certain something has fallen down the patient's throat.

"The minimum standard of dental performance while performing surgical implant treatment requires that a dentist utilize prophylactic measures to prevent a patient from swallowing or aspirating any foreign objects during the surgical placement and/or removal of implants," states the Florida Department of Health complaint. "Dr. Meyers failed to employ any of these measures on at least two separate occasions and failed to meet the minimal standard of dental performance in his treatment of patient CG [Charles Gaal]."

Dr. Meyers could not be reached for comment.