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CASE REPORT
Year : 2019  |  Volume : 46  |  Issue : 3  |  Page : 103-105

Accidental diagnosis of a foreign body embedded in maxillary anterior tooth


1 Department of Pedodontics and Preventive Dentistry, UCMS and GTB Hospital, New Delhi, India
2 Department of UCMS and GTB Hospital, New Delhi, India

Date of Web Publication28-Jan-2020

Correspondence Address:
Dr. Deepak Khandelwal
Department of Pedodontics and Preventive Dentistry, UCMS and GTB Hospital, New Delhi - 110 095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_29_19

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  Abstract 


Accidental ingestion or aspiration of a variety of foreign bodies is a common pediatric emergency. A foreign body in the tooth, however, is rare. Retrieval of foreign objects from the teeth in children is a challenging aspect of pediatric dental practice. In most of the situations, the foreign objects are diagnosed in routine radiographs, which play a vital role in analyzing the location, size, and type of the foreign object. Removal of the foreign body is not very difficult if it is confined to the pulp chamber or root canal. This article describes two cases of foreign object embedded in the teeth, the possible etiology, and treatment.

Keywords: Foreign body, retrieval, trauma


How to cite this article:
Khandelwal D, Kalra N, Tyagi R, Khatri A. Accidental diagnosis of a foreign body embedded in maxillary anterior tooth. J Sci Soc 2019;46:103-5

How to cite this URL:
Khandelwal D, Kalra N, Tyagi R, Khatri A. Accidental diagnosis of a foreign body embedded in maxillary anterior tooth. J Sci Soc [serial online] 2019 [cited 2020 Jun 4];46:103-5. Available from: http://www.jscisociety.com/text.asp?2019/46/3/103/276994




  Introduction Top


Children develop the habit of inserting foreign objects into the mouth, with some developing a persistent habit and when traumatized, they do not report it to the parents with the fear of punishment.[1] The incidence of foreign object in the pulp chamber and root canals is most frequently seen in children because of this habit of inserting them into the mouth.[2] Removal of the foreign body is not very difficult if it is confined to the pulp chamber or root canal. However, if it has been pushed periapically, the procedure becomes more complicated.[3]

Often, such objects can act as a potent focus of infection which is followed by complications.[4] Various foreign objects embedded in the pulp chamber and root canal of the tooth have been reported such as pencil leads and staple pins.[5] The chance of foreign object getting impacted in the teeth is more common when the pulp chamber is open because of traumatic injury, large carious exposure, or incomplete root canal procedures.[2],[6] In most of the situations, the diagnosis is often made accidentally as the tooth remains asymptomatic and the presence of foreign body is revealed only during routine radiographic examination.[2] The tooth may be associated with infection, pain, swelling, and recurrent abscesses as sequelae to pulp exposure and lodgment of the foreign body.[7] Retrieval of foreign objects in root canals is a challenging part in pediatric practice.[1] The foreign body may hinder the complete debridement of root canal and can also act as a potential source of infection.[6] Hence, their removal is necessary to re-negotiate the canal and complete the root canal treatment successfully. If the object has been pushed apically, their retrieval becomes complicated and surgery becomes unavoidable.[2] This article describes two cases of foreign object embedded in the teeth, the possible etiology, and treatment.


  Case Reports Top


Case 1

The following case describes the successful retrieval of a stapler pin from permanent maxillary anterior tooth. A 13-year-old girl reported to the Department of Pedodontics and Preventive Dentistry, UCMS and GTBH Delhi, India, with a chief complaint of pain in the left maxillary central incisor.

The patient had a history of trauma to the front tooth 1 year back and severe pain from the last 3 days. History revealed that the patient had undergone root canal treatment of the same tooth 9 months back, but treatment was not completed. Radiographic examination of the tooth revealed a radiopaque object resembling a thin piece of a stick overlapping the image of the tooth [Figure 1].
Figure 1: Case 1 – Intraoral periapical radiograph

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The stapler pin was confirmed to lie within the root by the same side lingual opposite side buccal rule. The access cavity was prepared properly; the pulp chamber was enlarged and irrigated with normal saline to remove the debris. An ultrasonic scaler was used to clear the debris from the orifice and facilitate loosening of the object. When the object was adequately visible clinically, it was engaged with a Shepherd's hook explorer and removed [Figure 2]. It was found out to be the broken lead of a pencil. The canal was copiously irrigated with saline, hydrogen peroxide, and sodium hypochlorite. After repeated dressings with nonsetting calcium hydroxide, the tooth was obturated in further visit and the tooth was given fixed prosthesis.
Figure 2: Case 1 – Clinical picture

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Case 2

A 12-year-old male patient reported to our department with a history of pain and pus discharge in the upper front tooth. He had suffered dental trauma 2½ months back for which no treatment was taken. The pain was relieved by taking medicine. For 1 week, the patient complained of pain. Radiograph was done to know the status of the tooth which revealed the presence of a radiopaque structure in the canal of the tooth which seemed like a stapler pin [Figure 3]. Following similar protocol as mentioned for Case 1, the foreign body was removed from the canal which was found out to be a stapler pin. Complete treatment was performed after removal of the pin from the tooth, and the patient was kept under follow-up.
Figure 3: Case 2 – Intraoral periapical radiograph

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  Discussion Top


Accidental ingestion of a foreign body is a common problem in children. Hence, there are chances of finding foreign objects in their teeth.[7] These troublesome incidents mainly involve children, especially if carious exposure, traumatic injury, or dislodged restorations result in an open pulp chamber.[3] Literature review shows that these incidences are more commonly reported in children, who have a tendency to keep foreign objects in the mouth, particularly while studying or watching T.V. Foreign objects are commonly diagnosed only in a routine radiographic examination due to the fear of punishment and unawareness by the children.[5] In the case reported here also, the patient had denied inserting anything in the tooth, but on probing further, the child mentioned a habit of placing pencil in the mouth while studying. In the second case, the mother reported that the child used to insert pointed objects (such as stapler pin) to remove food particles from his teeth.

Food impaction may be the reason for which children insert objects into the teeth, which then becomes a habit over a period of time.[3] These foreign objects may act as a potent source of infection.[7]

A number of foreign objects have been reported to be lodged in the pulp chamber and root canals of both deciduous and permanent teeth. Metallic paper clip, metal screws, pencil lead, stapler pins, darning needle, beads, plastic chopsticks, toothpicks, indelible ink pencil, ink pen tips, brads, tomato seed, crayons, dressmaker pins, two straws, conical metal objects, hat pins, aluminum foil, etc., have been retrieved from root canals.[8] McAuliffe et al. summarized various radiographic methods to be followed to localize a radiopaque foreign object as parallax views, vertex occlusal views, triangulation techniques, stereoradiography, and tomography.[9] Retrieval of pencil tips, toothpicks, absorbent paper points, and tomato seed has been reported by Paul et al.[3]

Steiglitz forceps are used for the removal of silver points from the root canal. There is a description of an assembly of a disposable injection needle and thin steel wire loop, formed by passing the wire through the needle being used. This assembly was used along with a mosquito hemostat to tighten the loop around the object.[10] For retrieval of foreign objects lying in the pulp chamber or canal using ultrasonic instrument, the Masserann kit and modified Castroveijo needle holders have been reported.[9] McCullock suggested that access to a foreign object is improved by the removal of small amount of tooth structure.[11] According to Walvekar et al., if a foreign object is snugly bound in the canal, the object may have to be loosened first and then should be removed with minimal damage to the internal tooth.[12] Hedstroem files provide a much easier and convenient technique in engaging any foreign objects in the root canal.[5] In our case, ultrasonic scaler and H files were used. Foreign object retrieval and calcium hydroxide dressing can help eliminate chronic peri-apical infection. Intracanal treatment alone may not solve the problem and apical surgery may be required.[3]

Weine recommends that the patient remains in the office with a draining tooth for an hour or even more and finally ending the appointment by sealing the access cavity. Hence, foreign body lodgment within the tooth can be avoided.[13],[14]

Complications may occur if these foci of infection are not removed at the right time. Chronic maxillary sinusitis of dental origin developed due to pushing of foreign bodies into the maxillary sinus through the root canals was reported by Costa et al.[15] Timely diagnosis and management are necessary to avoid further complications.[7]


  Conclusion Top


Foreign bodies may get entrapped or embedded within the root canal system of a tooth due to self-inflicted injury or iatrogenically. This is commonly seen in carious teeth which have been left untreated or in teeth which have dislodged restorations or long-term untreated traumatized teeth. Many of the patients do not seek treatment as long as the tooth is asymptomatic. Proper counseling is required to ensure that dental treatment is provided at the earliest to avoid further complications.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rangeeth BN, Moses J, Reddy NV. Self-injurious behavior and foreign body entrapment in the root canal of a mandibular lateral incisor. J Indian Soc Pedod Prev Dent 2011;29:S95-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Yadav RK, Tikku AP, Chandra A, Rathinavel C, Shakya V, Bharti R. Endodontic management of foreign body in the root canal-case series. Int J Sci Res Publ 2015;5:1-3.  Back to cited text no. 2
    
3.
Paul G, kuriakose S, Sreejith KR. Unusual foreign object in the root canal. Health Sci 2013;4:1-4.  Back to cited text no. 3
    
4.
Roig-Greene JL. The retrieval of foreign objects from root canals: A simple aid. J Endod 1983;9:394-7.  Back to cited text no. 4
    
5.
Ramugade MM, Sapkale KD, Metkari SS. Patient induced unusual metallic obturation of the root canal of permanent maxillary central incisor with an immature apex – A rare case report. Singapore Dent J 2014;35:77-82.  Back to cited text no. 5
    
6.
Mahesh R, Waseem H, Siva Kumar M. Unusual behavior in children – Foreign object in tooth: A report of two cases. Ethiop J Health Sci 2014;24:369-73.  Back to cited text no. 6
    
7.
Pereira T, Pereira S. An unusual object in the root canal of a primary tooth – A case report. Int J Paediatr Dent 2013;23:470-2.  Back to cited text no. 7
    
8.
Kariya PB, Singh S, Mallikarjuna RM, Govil S. Dental neglect leading to foreign body lodgement in pulp chamber. Adv Hum Biol 2016;6:145-8.  Back to cited text no. 8
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9.
McAuliffe N, Drage NA, Hunter B. Staple diet: A foreign body in a tooth. Int J Paediatr Dent 2005;15:468-71.  Back to cited text no. 9
    
10.
Pereira T, Shetty S. An unusual foreign object in a tooth. Niger J Gen Pract 2018;16:30-1.  Back to cited text no. 10
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11.
McCullock AJ. The removal of restorations and foreign objects from root canals. Quintessence Int 1993;24:245-9.  Back to cited text no. 11
    
12.
Walvekar SV, Al-Duwairi Y, Al-Kandari AM, Al-Quoud OA. Unusual foreign objects in the root canal. J Endod 1995;21:526-7.  Back to cited text no. 12
    
13.
Weine FS. Access cavity preparation and initiating treatment. In: Weine FS. Endodontic Therapy, 3rd ed. St. Louis, MD, USA: C.V. Mosby company; 1982. p. 207-55.  Back to cited text no. 13
    
14.
Aduri R, Reddy RE, Kiran K. Foreign objects in teeth: Retrieval and management. J Indian Soc Pedod Prev Dent 2009;27:179-83.  Back to cited text no. 14
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15.
Costa F, Robiony M, Toro C, Sembronio S, Politi M. Endoscopically assisted procedure for removal of a foreign body from the maxillary sinus and contemporary endodontic surgical treatment of the tooth. Head Face Med 2006;2:37.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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