The Charming Tale of Charm Needles!

Abstract

Charm needles or susuk are needle-shaped metallic objects inserted subcutaneously in
different parts of the body. The practice of inserting susuk is, an indisputably cultural and
superstitious traditional belief common in the south-east Asian region, especially to the people
of Malaysia, Thailand, Singapore, Indonesia and Brunei. With increased use of diagnostic
radiographs in dental or medical practice, the discovery of charm needles has become more
frequent. We report one such case of charm needles inserted in oro-facial region which was
discovered in routine dental radiograph, with emphasis on cultural and traditional belief.

Full text

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Nitte University Journal of Health Science
NUJHS Vol. 7, No.2, June 2017, ISSN 2249-7110
Introduction
Intentional modifications of the body for non-medical
reasons like aesthetic reasons, religious reasons, and to
show self-expression is called body modification. Piercing,
Tattooing, branding, scarification and surgical implants are
few examples for body modification. Not all of them
originated at the same time, while some practices have
been around for thousands of years, others have just begun
to gain fame in recent years. One such practice of piercing
foreign objects especially in the cranio-facial region is
called 'Susuk' or 'Charm needles'. Their insertion in the
body is a superstitious, cultural and traditional belief,
which is common in the south-east Asian region, especially
to the people of Malaysia, Thailand, Singapore, Indonesia
and Brunei [1, 2].It is usually seen in Malay Muslim women
and to a lesser extent in Chinese and Indian women [3, 4].
Most needle-wearers wish to keep the existence of the
needles a secret [5]. Unavoidably, some susuk wearers
seek medical and dental treatment and this secret is
revealed on the radiographs. The purpose of this article is
to present a case of charm needles inserted in oro-facial
region and discuss the cultural and traditional aspect of
such practice.
Case Report
A 38-year-old Malaysian Chinese woman reported to a
Dental Institute of Malaysia, complaining of stains over her
teeth. Routine diagnostic panoramic radiograph revealed
multiple linear radio-opacities of about 10 mm size
distributed in several areas (n=11) throughout the image
[over the right zygomatic buttress (2), left maxillary sinus
(3), cervical third of root of 16 (1), cervical third of root of 27
(1), posterior to 38 at external oblique ridge (1), below the
The Charming Tale of Charm Needles!
1 2 3
Sham Kishor Kanneppady , Sowmya Sham Kanneppady , Anusha Rangare Lakshman , Khoo Suan
4 5
Phaik , Shishir Ram Shetty
1 4
Senior Lecturer, Professor and Associate Dean, Division of Oral Diagnostic Sciences, School of Dentistry, International
2
Medical University, Kuala Lumpur, Malaysia. Senior Lecturer and Head, Department of Pharmacology, Faculty of
3
Medicine, Lincoln University College, Selangor, Malaysia, Reader, Department of Oral Medicine and Radiology, Century
5
International Institute of Dental Science and Research Centre, Kasaragod, India, Assistant Professor, Department of Oral
Medicine and Radiology, College of dentistry, Gulf medical University, Ajman, United Arab Emirates.
*Corresponding Author : Sham Kishor Kanneppady, Senior Lecturer, Division of Oral Diagnostic Sciences, School of Dentistry,
International Medical University, Kuala Lumpur, Malaysia. E-mail : drsham.omr@gmail.com
Case Report
Received :
Review Completed : 06.05.2017
Accepted : 18.05.2017
04.03.2017 Abstract
Charm needles or susuk are needle-shaped metallic objects inserted subcutaneously in
different parts of the body. The practice of inserting susuk is, an indisputably cultural and
superstitious traditional belief common in the south-east Asian region, especially to the people
of Malaysia, Thailand, Singapore, Indonesia and Brunei. With increased use of diagnostic
radiographs in dental or medical practice, the discovery of charm needles has become more
frequent. We report one such case of charm needles inserted in oro-facial region which was
discovered in routine dental radiograph, with emphasis on cultural and traditional belief.
Keywords : Susuk, charm needles,
spiritual healing, traditional belief,
panoramic radiograph
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67
Nitte University Journal of Health Science
NUJHS Vol. 7, No.2, June 2017, ISSN 2249-7110
apex of 33 and 34 (1), at the symphysis region close to lower
border of mandible (1) and below the apex of 44 and 45 (1)]
(Fig. 1). Intra oral periapical radiograph of maxillary right
posterior region was taken to confirm the existence of
radio-opaque objects (Fig 2). Its density was comparable
with that of silver amalgam. On close examination of the
object using magnifying glass it was observed that the
material is of fine needle-shape with a broader base and
pointed tapered tip (Fig. 3).
Fig. 1 : Panoramic radiograph showing multiple (n=11) charm
needles over the mandible, maxillary molars and maxillary sinus
region (needles are highlighted with white circles).
Fig. 2 : Intra oral peri apical radiograph showing charm needle
over the root of 27 (needle is highlighted with black rectangle);
the density of the object is comparable to that of silver amalgam
restoration.
Fig. 3: Magnified image of a linear radio-opaque charm needle
revealing its fine needle shape with broader base and pointed
tapering tip.
After confirming the absence of any foreign objects either
in the film cassette or in the film and ensuring the proper
radiographic technique, the patient was interviewed
regarding these multiple needle-like objects over her face.
The patient hesitated to report that the insertion of small
needles over her face about 10 years ago to maintain and
improve her facial aesthetics. After discussing with the
local staffs and considering the radiographic findings, we
came to the conclusion that the needle-like objects could
be charm needles or more popularly known as Susuk. On
palpation of the facial tissues, the needles could not be felt.
As the patient neither had any discomfort nor pain with
their presence, no surgical intervention was performed. As
a treatment for her complaint, oral prophylaxis was done
and oral hygiene instructions were given.
Discussion
Charm needles or susuk are needle-shaped metallic
objects inserted subcutaneously in different parts of the
body. Unlike other types of body modifications, charm
needles are not visible over the body surface. They are
inserted in the body as talismans and they are assumed to
improve the health and beauty of the wearer, cure
headaches and joint pains, protect the wearer from hurt
and accidents, improve relationship or attain success in
business and career [5-7]. Charm needles are generally
inserted in the cranio-facial region, and less often in other
areas of the body like the breasts, chest, abdomen, limbs,
spine and mons pubis [2-4, 6]. In the cranio-facial region,
the most common sites for insertion are over the mandible
followed by forehead, cheeks and lips [1, 4]. In the present
case, the insertion was at the middle and lower third of
face.
Charm needles are inserted in the soft tissues of the body
by 'bomoh', also called traditional healers (who practice
herbal medicine), magician, medicine man, shaman, native
practitioner or Malay medicine man. Their main task is
spiritual healing and prediction [1, 2, and 8]. The needles
are inserted subcutaneously by gentle rubbing on the skin
such that it is painless and leaves no puncture marks or
blood [1, 4]. The method used for insertion is traditionally
passed down over generations. It is not sure whether

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Nitte University Journal of Health Science
NUJHS Vol. 7, No.2, June 2017, ISSN 2249-7110
hypnotism is used during the procedure. It is predicted
that as susuk is inserted without anaesthesia, on insertion,
the patient may feel pain, depending on size and shape of
susuk. Some patients may come upon mild bleeding on
insertion of larger susuk [2]. Susuk is usually needle or pin
shaped, measuring about 0.5 mm in diameter and about
0.5–1.0 cm in length [2, 8].
Susuk are mostly made of gold, followed by silver and often
mixed with copper. The analysis of the chemical
composition found an average gold content of 89.75% and
copper content of 10.25% [2, 6]. Gold is preferably used as
it is biocompatible with tissues and noncorrosive while
copper is used to increase its hardness and malleability [4,
6]. There are also other forms of talisman made of diamond
and shaped by means of the normal diamond cut.
Acupuncture needles can be differentiated by charm
needles as they are usually longer and finer and are not
normally embedded in the subcutaneous tissue.
Radiographs are the ideal diagnostic tools for confirmation
of the presence of susuk. There are no reported artifacts
observed in radiographs due to the presence of charm. of A
study by Balasundram et al [9] stated that the ultrasound
imaging which was done in their patients to detect the
needles was disrupted due to echo reflection and images of
white striations that resembled reflective figures of metal
made the localization of charm needles in the soft tissue a
difficult task. Nambiar et al [3] in his study using 1.5-T MRI
machine stated that charm needles showed no
ferromagnetic characteristics and it was safe for patients to
undergo MRI. However, it is plausible that an object that
exhibits “no ferromagnetism” or weak ferromagnetic
qualities in association with a 1.5-T MR system may be
attracted with sufficient force to pose a hazard to an
individual in an MR environment that has a magnet
operating at 2.0-T or higher [9]. At present, the pertinent
literature does not contain carefully controlled studies that
establish the absolute safety of charm needle exposure to
powerful magnetic fields.
The number of needle insertion varies. In a study of 33
susuk wearers, Nambiar et al [3]observed between 1 to 39
needles in the cranio-facial region while Oon [10] had
reported between 1 to 47 susuk in a patient. Nor et al [2]
reported 80 susuk noted in the face of a single patient. In
our case, there were 11 charm needles in oro facial region.
Susuk usually remain intact for many years but can break
into smaller pieces due to corrosion and muscle
contractions [5]. The threat of foreign bodies in modern
day surgical practice is evident. Migration of these
substances causing vascular and nerve injuries in the
extremities have been reported [7, 11]. These foreign
bodies also cause increase risk of infection whether
immediately upon insertion or at a later date, which
requires their surgical removal. However, it is suggested
that they should be left alone, unless they lead to infection
or complications.
In conclusion, a wide range of surveys in literature suggests
that religious, spiritual, and traditional beliefs and
practices may provide positive benefits, although in some
cases mixed or negative consequences to mental and
physical health. There is no study done to prove that susuk
placement sustains/improves facial aesthetics. But
certainly, it gives a strong psychological benefit for the
wearer...lifelong!
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