Oral Medicine and Oral Diagnosis Competency Case

1. Oral Medicine and Oral Diagnosis Competency Case David Rainwater Fall 2010

2. Patient Information • Pt ID: 546-5-48 • 10 year oldMiddle Eastern male • No significant health history and no medications • Pt presents with a high caries rateandpoor oral hygiene/home care

3. Presentation • Patient presents with a “swelling near my back tooth.” • Swelling was NOT painful • Patient stated that swelling had just recently appeared, 1-2 days prior to dental visit • Lesion was NOT present upon initial diagnosis (completed 1 month prior) • Pano/radiographs did not show any abnormalities of the area.

4. Lesion Description • Lesion appeared as a single, swollen, sessile, nodule that was fluctuant upon palpation. The lesion was erythematous in the center, but normal gingival color surrounding the ill-defined borders. • Lesion appeared to involve the connective tissue only. • Purulent discharge was seen upon palpation.

5. Lesion Appearance

6. Lesion Appearance

7. Lesion Appearance

8. Patient Dialogue • When did you first notice this lesion? • 1-2 days prior to appointment • Have you recently been eating any chips or popcorn? • Yes, two nights ago • Have you ever had a swelling like this before? • No • Have you had any type of trauma in this area recently? • No

9. Diagnosis • Differential Diagnosis: • Periodontal Abscess • PyogenicGranuloma • Lipoma • Peripheral Giant Cell Granuloma • Provisional Diagnosis: • Periodontal Abscess • Final Diagnosis: • Lesion confirmed as perio abscess due exploring pocket and finding a piece of popcorn kernel causing abscess

10. Piece of popcorn kernel found upon probing and irrigation.

11. Treatment Plan • Remove debris that is causing the swelling and inflammation • Irrigate area with Chlorohexidine • Tell patient to monitor area and call if swelling does not subside