It's not unusual. Have seen it when patients are hard to intubate, oral surgeries. 

this patient may be at a higher risk as there probably wasn't a ET tune occupying the glottis, why the tooth detached would probably be associated with the type of technique was used to access the tonsils and adenoids and the oral opening.

Thanks for sharing this case. I had an 80 yrs old lady with multiple co-morbidities and refered to me after several attemps to extract tooth. It was impacted deeply as they pushed it deeper till it was in the lung parenchyma. I bronchoscoped her but could no get it out. The patient kept on antibiotics and follow ups. She did not have and issues although I expected lung abscess and others. I left her for follow only. 

This is not common as most of us automatically check for tooth stability before applying the Davis-Boyle mouth piece but it can happen either during a difficult intubation (here he was tracheostomised and so it's the surgeon who had to take care!). It is my routine to recheck the teeth after taking the gag out especially if there is some blood on the gums. In case a tooth is missing, we keep the tube in until the missing tooth is found usually in the oral cavity. In other cases a diligent search is made usually by telescopic bronchoscopy. If nothing is found the patient is kept under observation and a good quality chest x-ray performed next day.

This can occur after any endotracheal intubation. It is more common in patients who have poor dentition. I have recently had a case report accepted which describes an unusual presentation of airway obstruction due to a tooth that was dislodged during the reintubation of a patient in intensive care.

Thank you dr Rajendram. Our child was with tracheotomy. We did not understand what happened.  

Yes this not unusual. During oral surgeries a loose tooth not taken care properly during intubation, surgery or during extubation might get dislodged. Some times might be forgotten also if pre op not accessed about dental status. We have encountered in 2 patients. One was tonsilectomy case. While extubation when we noticed it bronchoscopy was done and tooth was removed from bronchus successfully. One has to take care that tonsillar fossa doesn't get injured and it must be done after necessary consent. Another case was head injury unconsious patient with # mandible with # lumbar spine who aspirated tooth, accidentally detected on x ray chest. Flexible bronscopy was advised to patient.

Thank you Dr Thorawade. Our patient had tracheostomy and was not with orotracheal tube.