Aspiration or dislodgement of an odontogenic foreign material potentially may result in serious complications including laceration, perforation and hemorrhage of the esophagus and gastrointestinal tract or even airway obstruction (1). The aim of this case report is to show that even an apparently uneventful general anesthesia, may ultimately lead to unpleasant surprises.
We report a case of a 43-year-old-woman scheduled for elective hysteroscopy and polypectomy in an outpatient unit. No other comorbidity was noted apart from dyslipidemia and class II obesity, with no other signs of predictably difficult airway. When questioned, the patient said she did not have any loose teeth, crowns, or dentures, both on preanesthetic assessment and on operation room. General anesthesia was performed, and a size 4 i-gel laryngeal mask airway was easily inserted, with no intercurrence.
At post-anesthetic recovery unit, the patient complained that her fixed partial denture (bridge) was missing and that it was already loose before. She had no symptoms of airway or esophageal obstruction.  A chest radiography showed her dental prosthesis in what appeared to be the esophagus. The patient underwent an endoscopy performed by a gastroenterologist and the denture was removed uneventfully. 
The presence of a dental prosthesis or loose tooth represents a threat to the patient's safety, especially if the airway is accessed2,3. Although most foreign bodies entering the oropharynx pass through the gastrointestinal tract without complications, it may be necessary to identify and remove it to avoid late complications (1,3).
A preanesthetic evaluation, including oral examination, is essential to ensure patient safety (1,2).
In our case, the assessment was performed but the patient omitted the presence of a bridge, putting herself into unnecessary risk. 
Adoption of a more extensive intraoral examination on preanesthetic evaluation maybe suggested to properly appreciate any vulnerable teeth or dental prosthetic. 

References:
1.	Lau G, et al. “Where Are My Teeth?” A Case of Unnoticed Ingestion of a Dislodged Fixed Partial Denture. Anesth Analg 2009;109:836 –8
2.	Yasny J S. Perioperative Dental Considerations for the Anesthesiologist. Anesth Analg 2009;108:1564–73 
3.	Windsor J, Lockie J. Anaesthesia and dental trauma. Anaesth Intensive Care 2008;9:355–7 



11 / The forgotten bridge – a case report