Sir, we would like to bring an interesting case to the reader's attention of a six-year-old boy that we recently saw in our paediatric dental department.

He presented with his anxious and worried mother, having bitten down onto a piece of Lego which was now firmly lodged onto his lower front tooth. The mother explained to us that her son has a tendency to bite on hard objects due to sensory issues associated with his autism spectrum disorder. Previous similar cases have been noted.1,2 However, the added complexity of this patient's behavioural needs proved challenging in our management of this young boy.

Examination revealed a grey, hollow, cylindrical piece of plastic Lego firmly encasing the lower left permanent central incisor (Fig. 1). The tooth exhibited grade 1 mobility. A limited radiographic examination confirmed this was his permanent tooth with no obvious abnormal radiographic signs.

Fig. 1
figure 1

Lego piece lodged on tooth

Full size image

Attempts to remove the piece by hand and fast handpiece proved futile as the underlying tooth was tender to pressure and his compliance and anxiety were increasing the longer he was in the dental surgery. Therefore, following discussion with his mother, arrangements were made for the boy to return the following day for removal of the Lego under general anaesthetic.

On contacting the parent later that day to confirm details of his admission, we were surprised and relieved to hear that her son had managed to detach the Lego piece from his tooth whilst eating a 'crunchy chocolate bar' snack, which he had received as a treat for being so brave at the dentist! Plans were made for clinical review of the tooth but unfortunately the family were unable to attend. A telephone review has been undertaken and his mother has confirmed that his boy's tooth (and Lego piece) have made a full recovery.

On discussion with our team, one of our dental nurses highlighted that this particular Lego piece (a wheel hub) has a lever to tighten/release its mechanism. Although we have not tested this theory, it may be possible to use this lever to remove the Lego without resorting to a planned general anaesthetic.