Breakthrough Clinical oral pathology case: No. 36

This is the oral pathology case of a purple asymptomatic "bump" on the lower gums of a 74-year-old female patient. Clinical assessment reveals a 3 x 3 mm soft, fluctuant nodule located on the lower attached gingiva between teeth Nos. 27 and 28.

Editor's note: This article first appeared in Breakthrough Clinical, the clinical specialties newsletter created just for dentists. Browse our newsletter archives to find out more and subscribe here.

Presentation and patient history

A 74-yr-old female presented with the complaint of an asymptomatic “bump” on her lower gums (figures 1 and 2). The patient stated that the lesion had been present for 10 months. A previous general dentist had referred her to an endodontist who performed root canal treatment on her tooth. At that time, the endodontist lanced the lesion and a clear fluid came out. He then placed the patient on a prescription of the antibiotic amoxicillin. However, the papule did not disappear and became darker. The patient presented to a dermatologist for further evaluation.

Clinical exam

Physical examination revealed a 3 x 3 mm purple papule located on the lower attached gingiva between teeth Nos. 27 and 28. Palpation revealed a soft, fluctuant nodule that was asymptomatic to the touch.

Figure 1: Initial presentation of "bump" on patient's lower gums

Figure 2: A 3 x 3 mm purple papule on lower attached gingiva

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

Send your answers to [email protected]. Next month, we will present the final diagnosis and recommended treatment for this oral pathology case.

CALL FOR PATHOLOGY CASES

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].

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Vincent J. Monticciolo, DDS, JD, MBA, is a graduate of the University of Detroit School of Dentistry. He earned his master's degree in business administration in 2001 and later his law degree in 2013. Early on, he found a way to improve his community by offering free dental care to struggling individuals who could not afford it. He and his wife, Dr. Natalie Monticciolo, began to think of how they could take this simple concept and turn it into something larger. After relocating to the Tampa, Florida area, they formed Dentistry from the Heart in 2001. Today, the charity helps coordinate more than 250 events in all 50 states, as well as internationally. Dr. Monticciolo practices full time in one of his six dental offices near Tampa Bay.

Natalie Lama Monticciolo, DO, is a board-certified dermatologist practicing in the Tampa Bay area in Florida. She founded and operates Prestige Dermatology. After receiving her medical degree from Michigan State University, she did her residency at NOVA Southeastern University. Her knowledge in skin diseases and cosmetic procedures comes from her extensive training, but her passion lies in skin cancer surgery. It is most rewarding to her when she helps others suffering from nonmelanoma skin cancer, melanoma, and other lesions that must be surgically removed.

Sophia Monticciolo is a high school student with a keen interest in pursuing dentistry after college. While she excels in all of her classes, she thoroughly enjoys her science courses. In 2014, she, along with her sister, started a charity called Socks 4 Love. The socks are filled with daily necessities—such as toothbrushes, toothpaste, sunscreen, soap, and lotion—and delivered to the less fortunate in her community and as far away as Peru. More than 7,000 prefilled socks have been donated since the charity’s inception.