Photo Quiz

A Bump on the Gum

 

Am Fam Physician. 2019 Jun 1;99(11):713-714.

A 10-year-old girl was brought to the family medicine clinic by her mother with a painful lesion on the left upper gum. The lesion was first noted about two months before the visit, when it was approximately 3 mm in diameter. The lesion had gradually increased in size. There was no discharge, but the patient had noticed a change in sensation in her gum. She had no constitutional symptoms or history of injury to the permanent tooth. However, the mother recalled that one of her baby teeth was pulled in preparation for braces two years earlier.

Physical examination revealed a lesion on the left upper anterior gingiva above the canine tooth (Figure 1). The round, erythematous lesion measured 8 mm in diameter. It was firm, nonpulsatile, and tender to palpation, and it did not bleed.

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FIGURE 1


FIGURE 1

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Dental abscess.

B. Langerhans cell histiocytosis.

C. Mucocele.

D. Pyogenic granuloma.

Discussion

The answer is A: dental abscess. Dental abscess is a subtype of odontogenic infection, which is one of the most common diseases of the oral and maxillofacial region.1 Classifications of dental abscess include periapical, periodontal, gingival, pericoronal, and combined periodontal-endodontic. Pain is one of the most common symptoms of dental abscess for which patients seek medical attention. The pain is usually moderate to severe and can be intermittent or persistent and sharp, throbbing, or shooting. Pain is absent in some acute cases. Swelling is almost always present, whether it is the acute or subacute phase. Patients sometimes describe a toothache with sensitivity to hot and cold and may have a history of a recent dental procedure.

Odontogenic infection is diagnosed with physical examination and imaging findings. The choice of imaging study varies with clinical setting.

Address correspondence to Nguyet-Cam Lam, MD, FAAFP, at Nguyet-Cam.Lam@sluhn.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Zamiri B, Hashemi SB, Hashemi SH, Rafiee Z, Ehsani S. Prevalence of odontogenic deep head and neck spaces infection and its correlation with length of hospital stay. J Dent (Shiraz). 2012;13(1):29–35....

2. Hurley MC, Heran MK. Imaging studies for head and neck infections. Infect Dis Clin North Am. 2007;21(2):305–353.

3. Hay W Jr., Levin M, Deterding R, Abzug M, Sondheimer J. In: Oral medicine and dentistry. Current Diagnosis and Treatment: Pediatrics. 22nd ed. New York, NY: McGraw-Hill; 2014.

4. Bali RK, Sharma P, Gaba S, Kaur A, Ghanghas P. A review of complications of odontogenic infections. Natl J Maxillofac Surg. 2015;6(2):136–143.

5. Baumgartner I, von Hochstetter A, Baumert B, Luetolf U, Follath F. Langerhans'-cell histiocytosis in adults. Med Pediatr Oncol. 1997;28(1):9–14.

6. Grois N, Pötschger U, Prosch H, et al.; DALHX- and LCH I and II Study Committee. Risk factors for diabetes insipidus in Langerhans cell histiocytosis. Pediatr Blood Cancer. 2006;46(2):228–233.

7. Huang W, Yang X, Cao D, et al. Eosinophilic granuloma of spine in adults: a report of 30 cases and outcome. Acta Neurochir (Wien). 2010;152(7):1129–1137.

8. Gonsalves WC, Chi AC, Neville BW. Common oral lesions: part II. Masses and neoplasia. Am Fam Physician. 2007;75(4):509–512.

9. Bodner L, Manor E, Joshua Z, Shaco-Levy R. Oral mucoceles in children—analysis of 56 new cases. Pediatr Dermatol. 2015;32(5):647–650.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.

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