HARD TO SWALLOW The dental bridge that took a 6-day journey through a patient's digestive tract

Patients need to be made aware that a challenging intubation can damage teeth, but how much damage is reasonable? What if a patient comes out of surgery looking as if he was on the losing end of a barroom brawl?

When 60-year-old Richard Martins of Linden, N.J., woke up from revision knee surgery last August, he discovered he was missing something — a permanent bridge that comprised his 3 front teeth — a development, he says, his anesthesiologist had failed to notice. He also says he'd told the anesthesiologist that he had 2 permanent bridges.

Staff searched the OR and PACU, but found nothing. Eventually, an X-ray confirmed everyone's worst fear. The bridge had been knocked completely out, he'd swallowed it, and it was now slowly making its way through his digestive tract.

Six days later, while he was still in the unidentified hospital, it finally passed without complications, but it had broken beyond repair, and a new one eventually had to be installed. The bill for the root canal and new bridge: $9,080.

Now what?

Mr. Martins tells Bamboozled, a consumer advocate service of NJ.com, that no one was in a hurry to step up and take responsibility. "The anesthesiologist told me that I might have bit down on the device in my mouth while I was unconscious," he says. Meanwhile, the hospital's patient relations rep, whom he spoke to twice, was noncommittal.

Next, his dentist's office said it didn't think his insurance would cover the bill, so it called the anesthesiology practice, which said it wouldn't pay either. Finally, a month later, he got a letter from the hospital: "It was determined that there was no deviation in the standard of care, therefore [the anesthesiology practice] respectfully declined to reimburse you for any dental repairs."

Fortunately, the story has a happy ending. When his dentist's office was nudged into actually submitting a claim, it turned out that between Mr. Martins's dental and medical insurance, he was covered, save for a $30 co-pay.

But some questions remain unanswered. Should the anesthesiologist have examined his teeth both before and after intubation? Should a mouth guard have been used? Was there really no deviation from the standard of care? What do you think?

Jim Burger