The crystal woman

A 34-year-old female presented with ‘a most bizarre presenting problem'. The patient had a history of polycystic ovary syndrome, epilepsy as a child and occasional asthma. She had allergies to sulphur and was lactose intolerant. In March 2008 she had a tooth extraction. Several weeks later she became aware of particles of material emerging from the gingivae when she brushed her teeth. Initially this began in the extraction quadrant but subsequently affected all quadrants. The material was not produced every time she brushed her teeth; a course of antibiotics resolved the problem for about a week. The material produced appeared as glassy, elongated particles of varying size ‘like clear plastic, but brittle' and larger ones could be Y-shaped. Clinical examination showed no obvious abnormalities to explain her story. Laboratory analysis established that the crystals were most likely to be magnesium carbonate, presumably precipitated out from toothpaste. The speed at which these crystals formed appeared to be quite remarkable.