Date: Thu, 24 May 2007 00:13:40 -0500
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 21 May 2007 to 23 May 2007 (#2007-51)

There are 5 messages totalling 297 lines in this issue.

Topics of the day:
1. Protocols for MIA
2. Re: MIA
3. Re: MIA
4. Re: MIA
5. Re: MIA


Date: Wed, 23 May 2007 06:00:12 -0500
From: "Joe" <jsmileb@NETWURX.NET>
Subject: Protocols for MIA

We do not have an absolute protocol for MIA situations.  Most often, when asking the patient when the problem may have occurred, they cannot say when.  That being the case, it is hard to justify the X-ray if the patient is not in any way symptomatic.  I use the analogy of the oft swallowed exfoliated deciduous tooth.  Medico-legally I am on thin ice, but practically it is not something over which I lose sleep.

Joe Brenner


Date: Tue, 22 May 2007 02:35:31 -0500
From: "Kevin Walde" <kwalde@SBCGLOBAL.NET>
Subject: Re: MIA

Dear Mark,

Usually we do nothing and it is fine. In 22 years I have sent a patient for an x-ray one time. In that case there was no problem. Regards, Kevin Walde, Washington, MO (Corn Cob Pipe Capital of the World)! ESCO automatic digest system wrote:


Date: Tue, 22 May 2007 11:37:59 EDT
From: "Ed Shagam" <BiteRight@AOL.COM>
Subject: Re: MIA

Hi Mark,  

I do the following for mias.....brackets that have disappeared I note on my chart as missing, and hope to find out when and how it happened. Small pieces of wire....I presume that they are in the distal end cutter, or, I have examined the oral cavity. If in doubt, have the patient rinse. Have an informed consent signed that acknowledges that it IS possible to swallow objects! Dr. Ed Shagam
Orthodontist, New Jersey
Marketing Consultant
Zoological Dental Consultant

Date: Tue, 22 May 2007 04:15:18 EDT
From: STinsworth@AOL.COM
Subject: Re: MIA

It has been my experience to first recommend per thoracic/general surgeon the patient eat some asparagus (or other binding/ bulky food element) to enshroud the item.    Await the swallowing event for about a week and then request a lower GI radiograph to verify that swallowed item has cleared the intestines with specific referal to radiologogist. Usually inhaled items will give a coughing repsonse,  pulmonary inflammatory response which can dictate an earlier chest film. This improves passage without issue, reduces film needs, and reduces anxiety  by having a logical plan to the process.  This is my experience over 30 years.

Date: Tue, 22 May 2007 16:14:25 +1000
From: "Allan J Ward" <award@ALBURY.NET.AU>
Subject: Re: MIA

MIA Mark and others, 2 years ago I had a young lass swallow a molar band while I was trying in for size. The defence insurer (ADA) advised just as you said, an Xray to verify it was in the stomach and a follow up later to see that it had been voided. Nothing came of it of course, but I too wondered about all the other "stuff" that patients swallow. For little bits of wire I think that an Xray is probably a waste of time as it wont show on it anyway. I asked a paediatrician about an ingested 2cm length of archwire several years ago and he said that any foreign body inhaled/aspirated would almost certainly result in a severe coughing/gag response. He was completely unconcerned that it had been swallowed. Apparently little kids swallow all sorts of foreign objects with no ill effects and often without their parents being aware that it has happened. Hope this ramble has been of use

Allan Ward
Albury NSW AUS