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Paper text:
foreign bodies may be ingested , inserted into a body cavity , or deposited into the body by traumatic or iatrogenic injury .
motor vehicle accidents , assaults , and bullet wounds are a common cause for traumatic foreign bodies .
the more common iatrogenic lesions include apical deposition of endodontic materials , mucosal amalgam and graphite tattoos , oil granulomas , and traumatically introduced dental materials and instruments .
these foreign bodies and tissues reactions to foreign bodies are commonly encountered in the oral cavity .
most of the foreign bodies cause abscess formation , septicemia or lead to severe hemorrhage .
those foreign bodies encountered in the oral cavity may present a diagnostic challenge due to many factors such as the size of the object , the difficult access , and a close anatomic relationship of the foreign body to vital structures .
complications caused by impacted foreign bodies include infections of peripheral nerve damage , pseudoneurysms and synovitis .
this paper describes an asymptomatic presentation of a foreign body ( stone ) in the oral mucosa which clinically appeared like a soft tissue swelling on routine intra - oral examination .
a 32-year - old male patient presented to the department of periodontics with the chief complaint of pain and food impaction in relation to 16 , the pain was continuous and dull in nature , on periodontal examination , bleeding on probing was present , with a probing pocket depth of 4 mm in the distobuccal region in relation to 16 .
intra - oral periapical radiograph did not reveal any pathology and no evidence of furcation involvement , except a crestal bone loss distal to 16 .
therefore , a provisional diagnosis of localized chronic periodontitis was made in accordance to the ( aap workshop 1999 ) and phase i therapy was planned .
on routine dental examination , the patient had a swelling in the mucogingival area of lower anteriors . extending from 32 to 42 and a miller 's class i recession in relation to 41 [ figure 1 ] .
this resulted in cuts and bruises in the face and oral mucosa , emergency care was given with sutures placed externally over the chin and it had healed uneventfully .
on inspection , the swelling measured 2 cm  2 cm , extending to the mucogingival area apically from the apical region of the lower anterior teeth with no surface and vascular changes [ figure 1 ] .
the swelling was hard , nontender and freely movable and was not attached to the underlying bone .
the mass was soft to rubbery - firm on palpation , with no surrounding induration .
the nodule was mobile and could be easily moved to the back of a mouth mirror .
the patient experienced no pain on palpation and was unaware of the presence or duration of the lesion .
an orthopantomograph showed a well - defined radio - opacity overlapping the roots in relation to 41 and 42 [ figure 2 ] .
there was no periapical involvement and on assessment , the vitality of the tooth was intact .
therefore , the provisional diagnosis of a foreign body embedded in soft tissue was considered .
exploratory surgery was planned under local anesthesia , with bard parker blade no 15 , a single vestibular incision was given extending from 32 to 42 for a depth of 3 mm into the area of swelling and a hard object was felt [ figure 3 ] .
the overlying thick fibrotic tissue was explored , and a black stone was seen embedded in the soft tissue .
the foreign body ( stone ) was removed in toto [ figures 4 and 5 ] .
the fibrotic tissue surrounding the foreign body was excised completely , and a simple interrupted suture was placed [ figure 6 ] and the patient was put under analgesics with postoperative instructions .
vestibular incision over the area of swelling black stone embedded in the soft tissue stone placed in the piece of gauze as there was also a grade i recession in 41 [ figure 1 ] , we planned to include root coverage using the bridge flap technique along with the foreign body removal .
however , the patient was not willing and , therefore , the procedure was not undertaken .
foreign bodies may be deposited in the oral cavity either by traumatic injury or iatrogenically .
glass pieces are the most frequently reported traumatic foreign bodies . frequently , it is difficult to detect these impacted foreign bodies clinically , and they pose a diagnostic challenge .
the visibility of different materials on plain radiographs depends on their ability to attenuate - rays .
foreign bodies may be visualized , depending on their inherent radio density and proximity with the issue in which they are embedded .
plain radiograph and computed tomography are able to reveal foreign bodies such as stones , displaced pieces of teeth various metals and glass . in our case report , the foreign body ( stone ) was clearly visible in the orthopantomograph and was radio opaque [ figure 5 ] . even if the patient is asymptomatic , removal of these foreign bodies is mandatory , since these objects usually lead to secondary infection , with abscess and fistula formation .
depending on the type of trauma , the composition and location of the foreign bodies can vary considerably as superficial and penetrating foreign bodies .
superficial bodies are usually easy to remove if seen , and penetrating foreign bodies are more difficult to remove .
it is necessary to determine whether the foreign body is near vital structures or not . in most documented instances , patients present with oral pain and signs of inflammation with purulent discharge .
reports of asymptomatic foreign bodies are rarely reported in the dental literature . in this case report
, the foreign body ( stone ) was retained in the labial mucosa for 3 years after closure of the wound , and the stone was deeply embedded in fibrotic tissue .
the patient was , however , unaware of the embedded stone and was completely asymptomatic .
this case report highlights the importance of a thorough and systematic intra - oral examination . though the lesion was asymptomatic at the time of examination , these retained foreign bodies are capable of causing inflammation , abscess formation as well as chronic pathologies including granulomatous tissue reaction , fistula formation and osteomyelitis if unnoticed and not removed .
though the patient 's primary complaint was food impaction , routine intra - oral examination revealed a neglected , asymptomatic foreign body for over 3 years .
this case report emphasizes the importance of a thorough and systematic dental examination , which would go a long way in avoiding local and systemic complications due to the foreign body .
foreign bodies may be ingested , inserted or deposited in the oral cavity . 
 iatrogenic foreign bodies such as impression material , amalgam , broken instruments , needles etc . , are commonly encountered . 
 these foreign bodies are generally symptomatic and show signs of inflammation pain and purulent discharge . an unusual case of asymptomatic traumatic foreign body ( stone ) impacted in the lower anterior region due to an accident 
 3 years back , which was diagnosed during routine oral examination is reported .