Dentistry

Breakthrough Clinical oral pathology case: No. 30

Sept. 3, 2017

A 22-year-old female presents for a comprehensive examination with no chief complaints. After referral to an oral surgeon for wisdom teeth removal, all contact is lost. Seven years later, the patient presents complaining of pain in her jaw that has been getting progressively worse. Based on the clinical findings, can you diagnose this oral pathology case?

Stacey L. Simmons, DDS, Editorial Director of DE's Breakthrough Clinical e-newsletter

A 22-year-old female presents for a comprehensive examination with no chief complaints. After referral to an oral surgeon for wisdom teeth removal, all contact is lost. Seven years later, the patient presents complaining of pain in her jaw that has been getting progressively worse. Based on the clinical findings, can you diagnose this case?

Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about it and subscribe here.

A HEALTHY, 22-YEAR-OLD FEMALE presented for a comprehensive examination. She had no chief complaints and no caries. The patient was referred to an oral surgeon for removal of wisdom teeth. Following that, all contact was lost (figure 1).

Figure 1

SEVEN YEARS LATER, the patient presented with this chief complaint: “Pain in lower right side of jaw that has progressively been getting worse over the course of the last 2-3 months; it feels like I have an infection in my wisdom tooth."

A panoramic was taken, and a large radiolucent lesion was noted to extend from the distal of No. 1 to the distal of No. 32. A significant amount of bone destruction in the mandible was observed. Furthermore, a radiolucency was present distal to the crown on No. 17. Clinically, there was inflamed tissue circa on partially erupted No. 32 that extended up to the distal of No. 2. The area was tender to palpation and unremarkable extraorally (figure 2).

Figure 2

What are your differentials and proposed recommended course of treatment for this patient?

Send your answers to [email protected] or join our Facebook group to discuss this oral pathology case and more. Next month, we will discuss the final diagnosis and recommended treatment for this case.

Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about it and subscribe here.

For more oral pathology articles, click here.

Do you have an interesting oral pathology case you would like to share with Breakthrough’s readers? If so, submit a clinical radiograph or high-resolution photograph, a patient history, diagnosis, and treatment rendered to: [email protected]. We will let you know if we select your case.

For more articles about clinical dentistry, click here.

Stacey L. Simmons, DDS, is in private practice in Hamilton, Montana. She is a graduate of Marquette University School of Dentistry. Dr. Simmons is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. She is the editorial director of PennWell’s clinical dental specialties newsletter, DE’s Breakthrough Clinical with Stacey Simmons, DDS, and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. Dr. Simmons can be reached at [email protected].

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About the Author

Stacey L. Simmons, DDS | Editorial Director of DE's Breakthrough Clinical e-newsletter

Dr. Stacey Simmons grew up in Hamilton, Montana. She did part of her undergraduate work at Purdue University and then received her bachelor’s degree in exercise physiology from the University of Utah. After applying to both medical and dental school, she decided that dentistry was her career of choice. She received her DDS degree from Marquette University School of Dentistry in Milwaukee, Wisconsin, in 2004. In private practice, she focuses her care on prosthodontics and cosmetic dentistry. She is a guest lecturer in the Anatomy and Physiology Department at the University of Montana. Outside the office, she trains for triathlons and spends time with her family. You may contact Dr. Simmons by email at [email protected].

In 2015, Dr. Simmons became the editorial director of DE's Breakthrough Clinical with Stacey Simmons, DDS, an e-newsletter focused on breaking through plateaus in clinical practice. Subscription information may be found here.

Updated May 4, 2016