biology zoology blog benno meyer rochow toothpick digestive system

Don’t Swallow a Toothpick

Your digestive system won’t like it

At conferences especially during tea or coffee breaks snacks are often provided and last year at a major international conference in Wuhan (China) that I attended it was no different. During the break, conference members gather around the tables on which the snacks are displayed and discuss the latest presentations, refresh memories or exchange ideas and some news. Every now and then one grabs a biscuit or a piece of fruit, something on the table, and shoves it into one’s mouth. On the first day of the conference that I refer to, cut pieces of pineapple were available, but there were no toothpicks stuck into them and therefore you used your fingers to take a piece.

The next day again at tea break, I saw the pineapple pieces (which had been juicy and tasty the day before), but I did not notice that now they had 4 or 5 cm long wooden toothpicks stuck into them. Hastily I grabbed a piece and plopped it into my mouth, but before I could take it out again, I had swallowed it plus the toothpick.

Of course, I was a bit worried when I felt the hard stick slowly making its way down my oesophagus, but at that time I wasn’t too worried, because I remembered having once seen in my childhood some “performers” who swallowed razor blades and glass shards. So, I reckoned a toothpick would probably also be no problem. During the next two or three days I did feel some slight discomfort in my abdomen, but I was actually very, very lucky. Had I been aware of an article that I came across some weeks later, I would have been extremely worried. In that article by C. Steinbach et al., published in 2014, it says of the 136 people who accidentally, like I, had swallowed toothpicks nearly 10% died from a puncture in the gut. 74% of the toothpick swallowers had been male individuals (females, I think, are always more careful and in much less haste than men). So what makes toothpick swallowing so dangerous?

The greatest danger is the pointed end of the toothpick, which can pierce the lining of the oesophagus, the stick can get stuck, or it may puncture the gut and then even penetrate a blood vessel causing internal bleeding. If the toothpick is made out of wood, it cannot be digested or even blunted by the acid in the stomach or the digestive juices of the duodenum. In the physiology test papers I used to hand out to my students, I often included a question that required the students to answer in detail how our digestive system would deal with a sardine sandwich. The idea was that the students had to consider the fates of the carbohydrates of the bread, the protein and the fat and the oil of the fish separately as the food would pass through our digestive system: the carbs being attacked by the saliva’s amylase in the mouth and later by maltase, lactase and invertase in the duodenum, the protein in the stomach being turned into peptides by pepsin in an acidic environment and then broken into smaller pieces and ultimately into amino acids by pancreatic trypsins and aminopeptidases in the almost neutral environment of the duodenum, and the fats being rendered absorbable through the addition of bile from the liver containing emulsifiers and lipases in the secretions from the pancreas.

Of course, I expected the students to provide detailed information on how and what caused the secretions of the various enzymes and the bile, which organs were involved, how absorption was regulated and which feedback loops were operating. But I never asked any question about swallowed toothpicks. To detect a swallowed toothpick X-ray is useless and endoscopy, computer tomography and ultrasound are also in only 70% successful in locating the wooden toothpick. I just wonder how recently doctors had detected that a woman had swallowed her toothbrush (it was reported in the news). It’s certainly a much surer way to get into the news than swallowing a toothpick, but is it also less dangerous than swallowing a toothpick? Perhaps we need another study by C. Steinbach et al.

© Dr V.B. Meyer-Rochow and, 2020.
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