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 Table of Contents  
Year : 2018  |  Volume : 10  |  Issue : 1  |  Page : 58-60

A mystical practice revealed on the radiograph: A case report and review

Faculty of Dentistry, SEGI University, Selangor, Malaysia

Date of Web Publication26-Feb-2018

Correspondence Address:
Dr. Ranjana Garg
Faculty of Dentistry, SEGI University, Selangor
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jioh.jioh_203_17

Rights and Permissions

Susuk, or charm needles, are needles made up of gold or other precious metals, which are inserted into the soft tissues of the body to act as talismans. Susuk has various supposed purposes, ranging from the purely esthetic to the treatment of joint pains and other minor ailments. This practice is also used as protection against injury and accidents. This obscured secret of inserting charm needles is a traditional belief and a cultural phenomenon, commonly practiced among Southeast Asian women. Here, we present two such interesting cases of this concealed art as the incidental radiographic finding, which was done on a routine basis as a part of diagnostic workup at our SEGi Oral Health Center.

Keywords: Charm needles, susuk, talisman

How to cite this article:
Garg R, Gupta VV, Dicksit DD, Singh AK. A mystical practice revealed on the radiograph: A case report and review. J Int Oral Health 2018;10:58-60

How to cite this URL:
Garg R, Gupta VV, Dicksit DD, Singh AK. A mystical practice revealed on the radiograph: A case report and review. J Int Oral Health [serial online] 2018 [cited 2022 May 19];10:58-60. Available from:

  Introduction Top

In every country, it is very common for people to have lucky charm. Some believe that wearing the charms such as iron or silver coins, chicken claws, bones, or skeleton dust is very common to be used in Western country. However, in Southeast Asia, there is a very well-known and powerful charm called susuk hidden inside the body.[1]

Susuk, or charm needles, are pierced gently into the skin by rubbing them over the skin of face and neck. They are believed to enhance charm and youthfulness, and other reasons such as treatment of any kind of aches and pains in the joints, back, or abdomen. The practice of inserting susuk or charm needles is a traditional credence, genuinely cultural and superstitious and more prevalent in the Southeast Asian countries, especially Brunei, Thailand, Malaysia, and Singapore. Since it is forbidden and unlawful, this service is done secretly and usually goes unnoticed. Most susuk wearers do not disclose the presence of these talismans in their body.[2]

In the present article, we have reported two such cases of Talisman, with incidental finding of needles inserted subcutaneously in the craniofacial region.

  Case Report Top

A 50-year-old female patient reported to the SEGi oral health center for the replacement of the missing teeth in maxilla and mandible. As the routine diagnostic process, the patient was subjected to the orthopantograph. In the radiograph, four linear radiopaque shadows mimicking pins were appreciated in the mandible. Clinical palpation did not suggest the presence of any needles. On taking the patient's history, she denied any history of dental treatment before. However, she reluctantly mentioned about the insertion of pins, under the skin of the face when she was young to retain youth and beauty. The needles were present in the orofacial region without the patient encountering any signs or symptoms [Figure 1].
Figure 1: Three pin-shaped radiopacities are seen in the mandible and 1 in between the crown of 28 and 48

Click here to view

In yet another similar case for the replacement of missing teeth in an elderly male, we came across a small pin-like radiopaque shadow in the mandible. However, the patient refused to give us the details. There was no history of any eventful dental treatment done till date. The patient did not want to have any more conversation associated with the susuk [Figure 2].
Figure 2: One pin-shaped radiopacity is seen in the right side of parasymphysis region

Click here to view

  Discussion Top

Susuk was once exclusively used by prince, princess, and nobles to increase their influences and personal charms. Most common areas of insertion of these needles are in the orofacial region as compared to the other body parts. Sometimes, it is also reflected as an “unscrupulous or unethical religious rite.” They are inserted in the soft tissues of the body by witch doctor or magic healer using the traditional methods and medicines. These needles, 5–10 mm in length and about 0.5 mm in diameter, are inserted slowly and gently under the skin leaving no external puncture marks.[2],[3]

Susuk is claimed to be embedded accompanied by invocations and chanting and is usually done at a particular time to increase its effectiveness. Placement of charm needles will traditionally be done during a special ritual which may include rubbing of oil over the site before the needles are inserted through the skin into orofacial soft tissues. The other methods of inserting these pins into the body are either by consuming through swallowing or by other mystical means (supernatural ways).[4]

Although the presence of susuk is controversial in many countries in Asia and some religions are forbidding the using of Susuk, the users of Susuk are keep on growing every day.

This talisman is believed to be done in Asian countries with an intent of appearing youthful and beautiful or to become resistant to minor ailments or to protect against injury and accident. A darker peril to susuk wearers is the notion that these taboos may last for life and are difficult and grueling to get rid of.[4]

It was also been stated in the literature that these needles need to be removed before death of the person. Susuk removal has to be done by the well informed and cultured person, usually the same person who inserted it in the first place. Charm needles were thought to be inserted for the youth and beauty and literature shows that removal of the needles will cause the person's face to revert to its natural wrinkled appearance within 6 months.[5]

Susuk wearers usually prefer to keep their insertions confidential because of this socially condemned tradition in the modern world. To make the power of susuk can work perfectly, the wearers are usually advised to follow some strict prohibitions, depending on the needs of the user. Usually, the bigger power the user needed, the bigger prohibitions he/she should avoid. The regular prohibitions are as follows:

  1. The user cannot eat some variants of banana (mostly golden banana and horn banana) and barbeque on stick
  2. The user also cannot walk under cloth string or walk near soiled road (e.g., wet mud)
  3. The user is not allowed walking under any stairs.

These needles are inserted sometimes at the very young age, so the wearer might be oblivious of its existence inside their body. These invisible implanted needles are usually detected incidentally when an X-ray is taken for diagnostic drives.[6]

There is lack of any published literature regarding the side effects or complications of the charm needles insertion. But still, there are high chances they can be inserted with the vital organs of the body and slowly can cause the unknown damage. Awareness of their insertions can enhance the planned patient management. According to Loh and Yeo, toxicity and harmful effects have not been attributed to these pins.[1],[7]

They are customarily made up of gold or silver and are often mixed with copper or other organic material. Susks were found to be chemically made up of gold content of 89.75% and copper content of 10.25%. Gold is favorably used as it is harmonious with tissues and noncorrosive while copper is used to increase its hardness and malleability. A study by Nambiar et al. concluded that susuk needles have no ferromagnetic characteristics and can safely undergo magnetic resonance imaging scans without any complications.[8],[9]

In relation to medical health sciences, these hidden talismans can lead to misdiagnosis. They may be mistaken for any kind of foreign bodies, especially in trauma cases. A few specifications or benchmarks may aid in making the diagnosis easy, i.e., most of the susuk needles are of the shape of pins and are inserted at multiple sites.[4]

Another possible misdiagnosis in dentistry is that a susuk may resemble an endodontic filling. Radiographs taken at the horizontal angulations, therefore, may help distinguish between an endodontic filling material and a charm needle.[2]

The PubMed review revealed several (15) case reports of Susuk in the orofacial region till date. The number of susuk charms per patient in the orofacial region ranged from 1 to 80.[10]

However, no reports have been found in the medical/dental literature regarding the complications associated with the insertion of these needles. However, the likely damage to the neurovascular structures can never be ignored.[11]

  Conclusion Top

The insertion of the susuks under the skin is a common practice in Southeast Asian countries as compared to the other places in the world. Now, because of the various countries' policies of increasing the tourism and education programs, these pin-like structures can be expected to be seen in any part of the globe. Furthermore, these amulets are kept as a secret inside the body. Therefore, it is very important to increase the awareness among the dentists about the existence of this mystical practice so as to minimize unexpected outcomes during diagnosis and treatment planning. The present case reveals an undisclosed fact which was not reported before and was shown in the radiograph and considered as the susuk because of its shape, location, and later on disclosure by the patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Loh FC, Yeo JF. Talisman in the orofacial region. Oral Surg Oral Med Oral Pathol 1989;68:252-5.  Back to cited text no. 1
Shanmuhasuntharam P, Ghani SH. Susuks: Charm needles in facial soft tissues. Br Dent J 1991;20:309-11.  Back to cited text no. 2
Sham Kishore K, Sowmya Sham K. The charming tale of charm needles! Nitte Univ J Health Sci 2017;7:2.  Back to cited text no. 3
Arishiya Thapasum F and Mohammed F. Susuk - Black Magic Exposed “White” by Dental Radiographs. J Clin Diagn Res 2014;8:ZD03-4.  Back to cited text no. 4
Nor MM, Yushar A, Razali M, Rahman RA, Ramli R. Incidental radiological findings of Susuk in the orofacial region. Dentomaxillofac Radiol 2006; 5:473-4.  Back to cited text no. 5
Pothiawala S. Incidental radiological finding of charm needles. Hong Kong J Emerg Med 2012;19:141-3.  Back to cited text no. 6
Soo YS, Singh J. Some radiological observations on the practice of insertion of “charm needles.” Med J Malaysia 1972;27:40-2.  Back to cited text no. 7
Nambiar P, Ibrahim N, Tandjung YRM, Shanmuhasuntharam P. Susuks (charm needles) in the craniofacial region. Oral Radiology 2008;24:10-5.  Back to cited text no. 8
Loh FC, Ling SY. Analysis of the metallic composition of orofacial talismans. Oral Surg Oral Med Oral Pathol 1992;73:281-3.  Back to cited text no. 9
Sharif MK. Horner S, Chadwick C. West. Susuk charms? A case report. Br Dent J 2013;215:13-5.  Back to cited text no. 10
Pande S. Incidental findings of Susuk in orthopedic patient. Brunei Int Med Journal 2011;7:177-80.  Back to cited text no. 11


  [Figure 1], [Figure 2]


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