Sir, we would like to present a very unusual case of giant dental calculus found on the maxilla and mandibular arches leading to facial swelling, lack of labial sealing and oral function impairments. The patient, who was female and 64 years old, was referred to the dental clinic of Varzelandia, Minas Gerais State, Brazil, due to a facial swelling and difficulties closing the lips. Her medical history revealed that she chewed tobacco, was malnourished and at general clinical examination revealed a noticeable cognitive impairment. It was noted in the history that the lesion had 20 years of progressive growth and the patient had not sought dental evaluation in that time. Due to the lesion, the patient reported severe difficulties socially and in swallowing, eating and talking. General haematological and coagulatory exams, glycaemia and blood pressure tests were normal. Renal dysfunction and diabetes were not shown. At ectoscopy, an evident facial swelling leading to absence of labial sealing and a perceptible oral mass and loss of weight were seen. The clinical oral exam revealed an extensive painful whitish brown mass, with hard consistency, absence of bleeding and detachment from the dental surface, involving the mandibular and maxilla right arches, mimicking a neoplastic lesion (Fig. 1). The teeth had generalised severe periodontal disease, intense amounts of dental calculus and dental mobility and evidence of oral care was absent. With the clinical diagnosis of giant dental calculus, the patient was submitted to mass removal with periodontal curettes and dental extractions were performed due to the periodontal disease. Following this treatment, complete healing was observed. The calcified material was radiographed and submitted to demineralisation and to haematoxylin and eosin staining. The microscopic examination revealed an amorphous basophilic material with mineral crystals (Fig. 2).

Figure 1
figure 1

The extensive whitish-brown mass mimicking a neoplastic lesion

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Figure 2: Radiopaque lesion with dental involvement and pseudolamelar formation.
figure 2

Basophilic material with crystals formation (Haematoxylin and Eosin, low magnification)

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Giant dental calculus has been previously described and could be associated with systemic conditions such as poorly controlled Type 2 diabetes.1,2 In this case, we removed the incredible size of the calculus and important oral function impairments associated with its presence. Microscopic findings also revealed basophilic material and crystals compatible with calcium phosphates.1 Indeed, 'tumoral presentation' can lead to misdiagnosis.