Foreign body aspiration, although not an uncommon problem in children, is unusual in adults and is overlooked as a cause of airway obstruction. Small foreign bodies that lodge in the peripheral airway are often asymptomatic initially and can result in respiratory symptoms several years later. Especially in the cases of otherwise healthy subjects, even though manifested overt respiratory symptoms, diagnosis can be delayed due to lack of history of aspiration or unnoticed aspiration. A 57-year-old male was admitted to Yonsei University College of Medicine Severance hospital due to left upper chest pain for five months. on the past history he had been diagnosed as bronchiectasis about 20 years ago. He showed radiologically bead-like bronchostenosis and a calcific density protruding into the lumen of left upper lobar bronchus. Bronchoscopically broncholith was revealed with the finding of endobronchial obstruction of each upper and lingular division of left upper lobar bronchus due to mucoid impaction and surrounding inflammed bronchial mucosa. The preoperative diagnosis was broncholithiasis due to chronic inflammatory process. Lung perfusion scan shows absence of perfusion in left upper lobe. So left upper lobectomy was performed. But from the pathologic specimen an incisor tooth was emerged. Later a history of tooth extraction thirty years ago at dental clinic was found. We report a case of bronchial obstruction due to occult aspiration of a tooth with a review of the literatures.