Case report
An 8-year-old boy was referred to an ENT specialist with acute pain in the right ear. The patient had initially been treated conservatively by a general practitioner, but upon further inspection with an otoscope, a “tooth” was found lodged deep in the auditory canal. The parents explained that the child had left the tooth under his pillow for the ‘Tooth Fairy,’ but it had inadvertently ended up in his ear. They mentioned that they had left money under the pillow despite not finding the tooth. The patient was unable to tolerate removal in the office, so he was taken to the operating room for the procedure under short general anesthesia. The tooth was successfully removed although with some difficulty due to its deep orientation in the canal. The tympanic membrane remained intact.
Discussion
The Tooth Fairy, a beloved figure in many cultures, has a history that blends folklore, tradition, and imagination. Its origins can be traced back to a variety of older customs surrounding children’s lost teeth. The practice of disposing of lost teeth goes back centuries, with different cultures having unique rituals.
One of the earliest recorded traditions comes from Northern Europe, where children were encouraged to bury their lost teeth in the ground or burn them to ensure the growth of strong, healthy teeth. In medieval Europe, children were told to offer their teeth to a mouse, which would bring them good fortune. This character, known as the “tooth mouse,” is said to have inspired the modern Tooth Fairy.1
In North America, the Tooth Fairy as we know it began appearing in children’s books in the 1920s. Children were more likely to have been visited by a “tooth fairy” who would leave a coin or gift in exchange for the lost tooth. These practices gradually blended with other childhood rituals, influenced by the rise of consumer culture and the commercialization of holiday figures.
The Tooth Fairy today is typically imagined as a small, winged creature who visits children at night, exchanging teeth for money or gifts. While the specifics of the Tooth Fairy’s appearance (whether pixie-like or sizable, as the “Rock” in the 2010 movie “The Tooth Fairy”) and actions may vary from family to family, the core idea remains: a magical figure who rewards children for letting go of their baby teeth as they grow older. The Tooth Fairy continues to be a cherished part of childhood for many across the world.
Although “complications” from Tooth Fairy interactions are rare, several reports in the literature do exist.2-5 It is important for dental practitioners to educate the patients, their parents, as well as the public on techniques (office giveaways, special tooth pouches/boxes, or homemade creations) for a safe, magical “financial” transaction. 
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References
- Parsons, CLB et al. Cultural diversity of traditions for the disposal of exfoliated teeth.: Implications for researchers. Community Dent Oral Epidemiol 2024. 52(2):139-149.
- Ludman, S, et al. A. The tooth fairy and malpractice. BMJ 2012;345:e3027
- Anon, JB, Pulec, JL. Foreign Body (tooth) in the External Auditory Canal. Ear, Nose Throat 1994. 73(8) 411, 1994.
- Carroll, WD, Lo, TM. Beware of the tooth fairy. Emerg Med J 2002. 19:360
- Ho, MR, Acevedo, M Baker, JE. Tooth fairy abscess. J Emerg Med 2008. 35: 2005
About the Authors
Dr. Bruce Pynn is the Chief of Dentistry/Oral and Maxillofacial Surgery at Thunder Bay Regional Health Sciences Centre and Assistant Professor at the Northern Ontario School of Medicine. He is Oral Health’s editorial board member for oral and maxillofacial surgery.
Dr Abdel – Hamid, Staff Otolaryngologist, Thunder Bay Regional Health Sciences Center.
