As if going to the dentist wasn’t anxiety-inducing enough, imagine the sudden terror of seeing your dentist’s “Whoops” face as a dental instrument drops down your throat. Instinctively, you swallow.

Though it’s rare, accidental swallowing of dental instruments happens — and can cause some serious complications. A new report highlights five cases that involved patients who swallowed or aspirated dental instruments. It provides dentists with practical guidelines to help prevent accidental ingestions from occurring, as well as ways to properly deal with it before the situation gets worse.

“Although three of these five cases of foreign-body aspiration or ingestion were caught early and the patients were referred for endoscopic retrieval, two patients experienced prolonged symptoms that affected their quality of life before intervention occurred,” the authors wrote in their case description. Indeed, realizing there’s a metal screwdriver in your stomach probably isn’t a fun thought. Though it may not kill you right away, it’s likely to cause some serious abdominal pain and potential problems if not removed early.

For example, in 2011, a 71-year-old woman named Lena David had a dental instrument in her stomach for a month before having it properly excavated. She filed a lawsuit against her dentist after he removed composite from six implant entrances on her denture, and then accidentally dropped a dental instrument into her mouth. The patient reflexively swallowed the instrument. Instead of being sent to the emergency room, David was instead told to receive an X-ray, which showed the device had gone to her stomach. The dentist, however, merely told her to eat a lot of fiber and to search for the screwdriver in her bowel movements. Almost a month later, David was suffering from sharp abdominal pain when she went to the hospital and had the dental device removed. She went through a “long and difficult recovery,” the lawsuit stated.

Swallowed items during dental procedures could range from teeth, restorations, instruments, and implant parts to gauze packs and impression materials, according to a report about dental patients accidentally ingesting devices. So this means that basically anything that the dentist uses in your mouth could be swallowed, though the chances of this are higher for young children or adults with psychiatric disorders.

If something like this happens to you, it’s important not to panic. Your dentist should be trained to deal with these kinds of events. If your airway is obstructed, he or she will most likely ask you to cough it up. If that doesn’t work, he/she will most likely perform the Heimlich maneuver. If the object has been fully swallowed, your dentist will reassure you and then send you to the hospital for a clinical examination, where the location of the object will be identified. You’ll then be referred to either a gastroenterologist or someone who will perform an endoscopy. If the object doesn’t come out in your bowel movements, the last resort is surgery.