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To the Editor: Dental caries is associated with halitosis, poor cosmesis, and discomfort. Bacterial overgrowth in the oral cavity can lead to aspiration pneumonia or endocarditis in elderly patients.^1-2 In the nursing home population, poor oral hygiene is common, with a 50% prevalence of dental caries.³ This report describes an unexpected consequence of dental caries in a demented patient.

Report of a Case

A 76-year-old male resident of a local nursing home was brought to the emergency department with a 3-day history of fever and cough. He had severe Alzheimer dementia and was unable to communicate. He had been fed through a gastrostomy tube for the past several years. Physical examination was remarkable for copious oral secretions, severe halitosis, and poor dentition. A chest radiograph revealed an aspirated dental bridge lodged in the cervical esophagus (Figure 1). The patient was taken to the operating room for direct laryngoscopy, bronchoscopy, and esophagoscopy with . . . [Full Text of this Article]

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