Endodontically Compromised Tooth and Associated Unusual Oral Habit: Foreign Object Entrapped in Tooth

Case Report

Austin J Dent. 2018; 5(5): 1116.

Endodontically Compromised Tooth and Associated Unusual Oral Habit: Foreign Object Entrapped in Tooth

Singh G1, Banda NR2*, Kandya A3 and Verma P4

1Private Practitioner, Gwalior, India

2Department of Dentistry, Ibn Sina National Medical College, Saudi Arabia

3Private Practitioner, Indore, India

4Private Practitioner, Jabalpur, India

*Corresponding author: Banda Naveen Reddy, Department of Dentistry, Ibn Sina National Medical College, Jeddah, Saudi Arabia

Received: April 28, 2018; Accepted: May 16, 2018; Published: June 12, 2018


Encountering foreign bodies in the oral cavity is not new; these foreign bodies may be left in the oral cavity as a result of traumatic injury or iatrogenically. A detailed history, and proper clinical and radiographic examinations are then essential to verify about the nature, size, location of the foreign body, and the difficulty involved for its retrieval. This situation more commonly arises in children as they have the habit of placing foreign objects in the mouth in order to alleviate their discomfort, which might get stuck inside the teeth, and are adamant to confess the same to their parents due to fear. These foreign objects may act as a potential source of infection and may later lead to a painful condition. This paper discusses a similar situation about the presence of an unusual foreign object within broken upper incisor and its management.

Keywords: Foreign body; Endodontic treatment; Paediatric patient; Oral habit


Various kinds of self imposed injuries in the hard and soft tissues of the oral cavity have been reported in the literature, which may have traumatic, iatrogenic or accidental causes [1]. These injuries may vary from simple nail/lip biting to a more severe form of trauma. Finding a foreign body inside a tooth is a special situation which is not a frequent encounter and in often diagnosed as a part of routine clinical or radiographic check-up, as the tooth often remains asymptomatic. Also, the patients are generally hesitant to reveal because of the fear from their parents [2-4].

These conditions are more commonly seen in children having an open pulp chamber due to trauma, caries or while undergoing root canal therapy. According to the literature, objects found inside the teeth may include pencil leads [2], stapler pins [5], incense sticks [6], safety pins [7], thorns etc. The embedment of these foreign objects may further complicate the situation by acting as a nidus of infection leading to pain and swelling (most commonly), recurrent abscess or may be haemorrhage. A case of actinomyosis of maxillary central incisor has also been reported due to the same reason [8].

This situation holds the need to retrieve the embedded objects from the root canal which in itself is quite challenging for the clinician but even more importantly for a pedodontist as they are dealing with a developing root canal [9]. The objects if located superficially in the pulp chamber can be retrieved in a relatively easier and faster manner; however, if the object has been lodged inside the root canal may complicate the situation further hampering the cleaning and shaping of the root canal and might even need a retrograde surgical removal, depending upon the size/shape of the object and diameter, curvature and accessibility of the root canal [4]. There is however, no standard protocol set for these kinds of procedure and different techniques and procedures have been used and reported in the literature till date [10].

Case Presentation

A 13-year-old boy was referred to the Department of Paediatric Dentistry, Modern Dental College and Research centre, Indore with the chief complaint of pain in maxillary permanent central incisors since 2 weeks. On examination, the patient had a Class I Angle’s molar relationship bilaterally. The right maxillary central incisor was discoloured and broken down (Ellis class IV tooth fracture [11]). Radiographic examination showed that the apices of both the incisors were closed. Periapical radiograph of tooth [11] showed a radioopaque object within the root canal (Figure 1). Another periapical radiograph was then taken (SLOB technique to confirm the location of the object) from a slightly different horizontal angle, using parallax, and it was confirmed that the metallic object was located within the root canal rather than in the periodontal ligament space. On further questioning, the patient admitted to ‘insert some object’ few months previously.