To the Editor:—
In the last 2 months I have encountered two cases in my personal practice in which objects had been cemented into the mouths of patients using cyanoacrylate cement (“super glue”) to conceal missing teeth and improve cosmetic appearance. In both cases the objects were dislodged during manipulation of a laryngeal mask airway (LMA). Before anesthesia, neither patient admitted to the presence of these objects in response to my direct question “Do you have any removable dental work in your mouth?” Either they did not consider the object removable or vanity or embarrassment kept them from mentioning it.
The first case was a 53-yr-old female presenting for an orthopedic procedure. At the end of an uneventful procedure, the LMA was removed at the appropriate time during emergence. As the LMA was removed, something that did not appear to be secretions was seen to fly from the mouth. A broken-off natural tooth was found on the bed next to the patient’s head. An inspection of the patient’s dentition revealed a gap where the left second upper incisor was missing, but this gap was well healed and there was no remaining root. After the patient was in the postanesthesia care unit, the tooth fragment was presented to the patient’s family. Her sister stated, “Oh, she will be so embarrassed! She has been gluing that in for a year.”
The second case was a 40-yr-old female presenting for a gynecological procedure. After induction, the index finger of my left hand was placed against the inner surface of the upper teeth to aid in opening the mouth as the LMA was inserted. I was dismayed to feel one of the teeth “give” under pressure and become dislodged. On recovery, the “tooth” was found to be a flat, curved fragment of plastic material that the nurses in the room felt was shaped from a white artificial fingernail. From residual glue on the adjacent teeth, it was evident that this had been attached to the short brown remnant of the root of the left second upper incisor and to the sides of the adjacent teeth. This had presented an excellent cosmetic appearance during my cursory evaluation of the patient dentition. Had the LMA been inserted without placing my finger in the mouth, this object could easily have been dislodged without my knowledge. Interestingly, the nurse who had prepared the patient for surgery had been told by the patient that a tooth had been glued in place. This was in response to the same question to which I had earlier received a negative response. Efforts to contact the patient for further information have been unsuccessful.
The occurrence of two such incidents in one practice in so short a time suggests that this practice may not be uncommon and that we should be aware of this possibility. A search of the Internet under “super glue tooth” reveals a number of articles relating to this practice, including specific directions on such dental repair,*an anecdote of a patient gluing a tooth before cesarean delivery,†and a hazardous business opportunity.‡
OSF St. Francis Medical Center, Peoria, Illinois. firstname.lastname@example.org.