Filler Christmas 2012: Research

The tooth fairy and malpractice

BMJ 2012; 345 doi: (Published 13 December 2012) Cite this as: BMJ 2012;345:e3027
  1. Sian Ludman, paediatric allergy registrar,1,
  2. Hamid Daya, consultant paediatric ENT surgeon2,
  3. Polly S Richards, consultant radiologist3,
  4. Adam Fox, consultant paediatric allergist1
  1. 1The Children’s Allergy Service, St Thomas’ Hospital, London SE1 7EH, UK
  2. 2St George’s Hospital, London SW17 0QT
  3. 3Barts and The London NHS Trust, Department of Diagnostic Imaging, St Batholomew’s Hospital, London EC1A 7BE
  1. Correspondence to: A Fox Adam_fox{at}

We are concerned that the actions of the mythical character at the root of this report must be brought to the attention of the medical community, as it seems to represent the first signs of a worrying new trend in malpractice.1 2 Previous anecdotal evidence suggests the tooth fairy is benevolent, but this opinion may need revising in light of mounting reports of less child-friendly activity.

An 8 year old boy was referred to a specialist allergy clinic with a history of profuse mucopurulent rhinorrhoea. After a failure of first line medical treatment, computed tomography of the sinuses was performed. This revealed clear evidence of changes consistent with sinusitis but also a calcified foreign body in the left external auditory meatus (figure).


Axial computed tomogram of the patient’s paranasal sinuses showing a hyperdense structure in the left external auditory meatus

The family spoke of an occasion three years earlier when the boy had woken from sleep, extremely distressed because the tooth fairy had put a tooth in his left ear. The tooth had initially been left under his pillow for the tooth fairy to collect and to leave some money in its place. Thinking this was a bad dream, the parents initially reassured the boy but were unable to locate the tooth. Nevertheless, his concerns continued, and on two occasions advice was sought from different general practitioners, when the auroscopy was thought to be normal.

Repeat auroscopy by the allergist confirmed the presence of a deciduous tooth in the auditory canal. The tooth was removed by an ENT surgeon under microscopic vision, and the patient decided to keep the tooth for posterity rather than taking the risk of attempting a further pecuniary reward. He kindly gave his consent for us to disseminate this information to save other children from going through this ordeal.

In the United Kingdom it is customary for children to put deciduous teeth under their pillow at night in order to receive a financial reward from the tooth fairy. In addition to our case, there are two other reports of possible malpractice on the part of the tooth fairy. The other cases involve a tooth in the upper oesophagus causing tracheal obstruction in a trauma situation,1 and a man who developed a nipple abscess after inserting his child’s milk tooth into the hole of his nipple piercing to keep his child’s tooth near to his heart.2

As far as we are aware, there is no revalidation procedure for the tooth fairy and no clear guidance or standard operating procedures in place to ensure adverse outcomes are avoided. We advise that medical practitioners should have a high index of suspicion with tooth related presenting complaints.


Cite this as: BMJ 2012;345:e3027


  • Contributors: SL wrote the manuscript and coordinated the collaboration. PSR provided the image and reviewed the manuscript. HD provided the surgical information and reviewed the manuscript. AF had the initial idea for the report and made the final review of the manuscript.

  • Patient consent obtained.