Unexpected death from air embolism during routine dental Procedure: A case report

Air embolism during dental treatment is a rare but severe complication. We report a woman in her 70 s who died of an air embolism. The patient experienced sudden stiffness and loss of consciousness while undergoing restorative treatment for cervical caries of the lower right second molar. Despite resuscitation efforts, the patient died 2 h later. Postmortem computed tomography revealed subcutaneous emphysema from the right mandible to the cervical area; gas within the right mandibular canal; and expansion of the right submental vein extending to the right anterior jugular vein, brain, cervical vessels, and heart chambers. An autopsy revealed mucosal abrasions and bleeding around the gingival mucosa, gas in the cerebral and cervical vessels, and an open oval foramen in the atrial septum. Histopathological examination revealed emphysematous and exudative changes in the granulation tissue and empty veins, indicating the presence of air surrounding the lower right second molar. In this case, routine dental treatment resulted in a fatal outcome, which was attributed to the following. First, the patient had fragile periodontal tissue, which made it prone to air infiltration. Second, the patent foramen ovale allowed air to pass from the venous to the arterial system, leading to systemic and cerebral air embolisms.