Diagnosis and treatment for Breakthrough Clinical oral pathology case: No. 15

Last month, Christopher Shumway, DDS, presented Breakthrough Clinical’s oral pathology case of a healthy 37-year-old male who presented with pain on the lower-left and lower-right sides of his mouth. A limited exam revealed rampant decay. The panoramic radiograph showed badly decayed teeth on the lower-right side, with an apical radiolucency and associated swelling in the buccal vestibule. Dr. Shumway gives the differentials and definitive diagnosis for this case, as well as the patient’s prognosis.

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This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.

Last month I presented the oral pathology case of a healthy 37-year-old male who presented with pain on the lower-left and lower-right sides of his mouth. He stated that he drank a lot of soda, and he knew his teeth were bad. He felt like the area was swelling and the associated pain was keeping him from sleeping.

A limited exam revealed rampant decay, and a panoramic radiograph showed badly decayed teeth on the lower-right side, with an apical radiolucency and associated swelling in the buccal vestibule. Also noted was a well-defined radiolucency above the apexes of Nos. 5–9. There was some expansion around the bone; the lesion was not fluctuant or mobile. Teeth Nos. 5–9 were severely decayed.


Differentials:
• Traumatic bone cyst
• Periapical granuloma

Definitive diagnosis:odontogenic/periapical (radicular) cyst

Radicular cysts are primarily found in the maxilla (60%) and are the most common of odontogenic cysts (52%). (1) Clinically, they are typically asymptomatic and found via radiographic examinations. If there is pain, it is due to a slow growth and subsequent swelling. Radiographically, these lesions have well-defined borders with an oval/round radiolucency. (1) If large enough, the roots of adjacent teeth can be displaced. If large enough and in the right location, jaw fracture is a potential. Other complications include “squamous cell carcinoma and epidermoid carcinoma arising from the epithelial lining.” (1) Treatment is complete enucleation of the cyst and surrounding lining.

The patient presented to the oral surgeon’s office, and all remaining maxillary teeth except Nos. 6–11 were removed. Prognosis is good. A partial is in the patient’s definitive treatment plan.

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Reference

1. Morrison A (reviewer), Magliocca KR (editor). Mandible-maxilla odontogenic cysts/periapical (radicular) cyst. PathologyOutlines.com, Inc. website. pathologyoutlines.com/topic/mandiblemaxillaperiapicalcyst.html Published 2004. Updated March 25, 2014.

This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.

Christopher Shumway, DDS, graduated from the University of Wisconsin–Madison, with a degree in zoology in 1999. In 2004, he graduated with honors from Marquette Dental School. He is a member of the American Dental Association, Wisconsin Dental Association, and Washington/Ozaukee County Dental Association. In addition to working in Slinger, Wisconsin, Dr. Shumway provides care to underserved children at a clinic in Green Bay two days a week. Outside of dentistry, his hobbies are fishing, running, camping, backpacking, and gardening.


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