Amalgam restoration or just a deposit? A riveting incidental
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Parafunctional oral habits are known to cause deleterious effects on maxillofacial structures. One such effect is traumatic injuries secondary to chewing inanimate objects like pencils. Following trauma, the lead of the pencil has been reported to embed in the soft tissue of the oral cavity, appearing as a grayish pigmentation (graphite tattoo).

Accompanied by parents, a four-year-old, female child reported and when enquired, she denied any discomfort, food lodgement, pain, or swelling with the tooth. Intra-orally, complete set of primary dentition was present. Instead of caries, a class I restoration was noted with 85. The tooth was non-tender on percussion and had a healthy periodontium. An intra-oral periapical radiograph (IOPAR) with 85 revealed a well-defined radiopacity on the occlusal aspect of 85, suggestive of a possible amalgam restoration. The radiopacity, however, was limited entirely to the enamel, also amalgam restorations are not usually indicated in pediatric patients. This raised suspicion, if the radiopacity was actually an amalgam restoration. Moreover, the patient’s parents had denied any previous dental treatment for the child. This reinforced the suspicion regarding the radiopacity evident with 85.

Hence, the parents were again thoroughly interrogated, upon which the mother recollected that the child had a habit of chewing lead pencils for the past two years and that she whines away from brushing her teeth. The parents assertively claimed this visit to be the patient’s first dental visit.

Keeping in mind these facts, the oral cavity was re-examined carefully. It was noted that all the molars had accentuated pits and fissures. The occlusal surface of 85 was carefully probed, leading to scraping off of some part of the suspected restoration. It was then gently scraped off from the entire occlusal surface, revealing a healthy, non-carious tooth with deep pit and fissures . The scraping was nothing but, graphite deposit owing to the patient’s habit of chewing lead pencil. Thus, a diagnosis of an exogenous deposit on the tooth mimicking a silver- amalgam restoration was formulated.

The patient was counselled regarding her habit and the parents were explained that how improving the emotional attachment between them and the child could prevent this habit from forming in the first place. Also, the benefits of regular, proper brushing were explained and how inculcating this habit in the child would go a long way in maintaining her overall health.