Incidental Radiographic Discovery of a Screw in a Primary Molar: An Unusual Case Report in a 6 Year Old Child

Dentists often find foreign bodies in the primary dentition of children who habitually place objects in their mouths. The objects are frequently embedded in exposures that result from carious or traumatic lesions or from endodontic procedures that have been left open for drainage. Such bodies are often detected on routine radiographs and, less frequently, during clinical examination. We report a case of a 6-year-old boy who had inadvertently embedded a screw in his mandibular right first primary molar and had forgotten about it until it became symptomatic. The screw was impacted in the exposed pulp chamber due to a large carious lesion in the affected molar. This case report considers the possible medical and dental consequences of placing foreign bodies in the mouth. 1. Introduction Many children are in the habit of exploring various objects in the oral cavity that can cause hard or soft tissue injuries. This practice may result in inadvertent insertion of foreign bodies within the pulp chamber or root canal [1]. Foreign objects are often discovered in the primary dentition during radiological examination. Radiographic examination assists in the determination of the number, type, composition, and position of the foreign object(s). Till date only two such cases of a screw impacted in a primary molar have been reported [2, 3]. 2. Case Report A 6 year old boy reported to the Department of Pedodontics, Terna Dental College, Navi Mumbai, India, complaining of pain in lower right back region of jaw, since 3–5 days. Intraoral clinical examination revealed deep occlusal caries and intraoral draining sinus in relation to #84. Vestibular tenderness and mobility were absent. An intraoral periapical radiograph of the tooth revealed presence of a linear radiopaque object (metallic screw) ？mm in dimension, which was embedded in the pulp chamber of #84 (Figures 1 and 2). A clinical history revealed that the patient habitually placed metal objects in his mouth; on one occasion, the screw had become lodged in the cavitated tooth. Several attempts by the child to retrieve it had proven futile. The child had not reported this incident to his parents for fear of punishment and had soon forgotten about it. A diagnosis of chronic dentoalveolar abscess with 84 was made. The treatment plan involved removal of foreign body from the pulp chamber of #84 followed by pulpectomy and stainless steel crown cementation. Figure 1: IOPA showing metallic screw in the pulp chamber of #84 with intact pulpal floor. Figure 2: IOPA showing intact furcal area with no evidence of interradicular