AN UNUSUAL SOCIAL HABIT LEADING TO A FOREIGN BODY IN TEETH

INTRODUCTION:

Impaction of foreign objects in the oral cavity is quite common among children because of their habit of placing various objects in their mouth and is often diagnosed accidentally¹. Similar reports in adults are however, infrequent. We present an incidental detection of a self-introduced unusual foreign body in molar tooth, about which the patient himself was unaware.

CASE HISTORY:

A 26-year-old male reported to the emergency room with the chief complaint of pain in the lower back left tooth region for past 2-3 days. The pain was dull in nature, continuous and aggravated on taking food. He also gave history of ongoing root canal treatment with respect to 37.

Clinical examination revealed a temporary restoration with respect to 37 (which was given after access opening done in the same tooth) and a partially erupted 38.

An orthopantogram [OPG] was advised which revealed a horizontally impacted 38 impinging onto the distal aspect of 37 and proximal caries with respect to 37 [Figure 1]. However, a small cylindrical artifact was evident on the radiograph appearing to be located in between teeth 37 and 38 that was not visible on clinical examination.

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Figure 1.

Orthopantogram showing a well-defined radiopaque foreign object in the tooth. The retrieved ball point of the pen [Inset]

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The patient was unaware of this foreign object that was detected on the OPG. Upon asking, the patient gave a history of picking his teeth with a ball point pen, mostly after food.

After a failed attempt to retrieve the foreign object with a probe and a tweezer was made, surgical removal of the impacted 38 was planned. A modified ward's incision was given and the periosteum was reflected. Odontectomy of 38 was done and the crown and roots were sectioned apart. The sectioned crown portion of 38 was removed first which aided in the removal of the foreign object which was wedged between the crown of 38 and the cervical portion of 37. The object was identified to be the tip of a ball point pen [Figure 2]. The roots of the sectioned tooth were then removed and wound closure was done with silk suture after thorough irrigation of the extraction socket.

DISCUSSION:

Foreign bodies lodged in teeth can be metallic or nonmetallic. The metallic objects can be readily identified from routine radiographs because of their radioopaque nature. These include broken instruments, canal obturation materials or foreign objects inserted by the patient himself¹. Among the various self-inserted objects are pencil leads, needles, metal screws, beads, nails, pins, wooden tooth picks and tooth brush bristles.

Complications reported due to these foreign objects include pain, swelling, infection, recurrent abscesses and chronic maxillary sinusitis of dental origin². Actinomycosis following placement of piece of jewellery chain into a maxillary central incisor has also been reported³.

A ball point pen is a pen that dispenses ink usually in paste form over a metal ball at its point. The components of a ballpoint tip include the freely rotating ball that distributes ink on the writing surface, a socket holding the ball in place, and a self-contained ink reservoir, a narrow plastic tube supplying ink to the ball. The tip can be detached from the plastic tube when a twisting force is applied that can happen during tooth picking using the pen. Our patient was apparently unaware of this detachment.

After such an accidental radiological detection, detailed case history and clinical evaluation are necessary to come to a conclusion about the nature and size of the foreign body. Careful instrumentation with patience is needed for retrieval of the foreign body. The patient should be counselled about oral hygiene and abstain from such practices.