Sir, I was intrigued to read the case report from Ghafoor et al.1 regarding an apparent reaction to retained amalgam following extraction which led the authors to make certain recommendations for dentists.

The letter describes a unique case where a large area of bone loss was attributed to an intra-osseous foreign body reaction as a result of amalgam displaced into an extraction socket some months previously. These statements left me with a number of questions as to the histology of the lesion, the reason for the earlier extraction and whether the history had been explored in sufficient detail as to exclude the presence of the pathology prior to the extraction.

Whatever the aetiology this is clearly a very rare condition and far more rare I suspect than the inadvertent retention of dental materials or tooth fragments following extractions. Whilst it makes perfect sense to retrieve any retained materials lost into an extraction socket I would question the appropriateness of referral as the authors advise. A more measured and cost-effective response would be to advise the patient of what has happened and to monitor healing of the socket, with periodic X-rays where they can be justified.