Case Report/Clinical TechniquesNon-Hodgkin's Lymphoma of the Anterior Maxilla Mimicking a Chronic Apical Abscess
Section snippets
Case Report
A 72-year-old man with American Society of Anesthesiologists grade 3 and a smoker (42 pack-years) with history of Waldenstrom's macroglobulinemia presented to his general dentist with a chief complaint of a “pimple in his gums, mobility, and pain to chewing” (on tooth #7). On examination, a facial fistula was noted in the interproximal of teeth #6 and 7 with yellowing of the clinical crowns (Fig. 1A). Class 2 mobility, pain to percussion, and a negative thermal response were observed on tooth
Discussion
NHL of the maxilla often mimics endodontic disease, frequently sharing characteristics of pain, swelling, tooth mobility, and radiographic destruction of supporting structures6,9,10,13,14,24,25. Current methodology for vitality testing can yield unreliable results5,11,15. However, if teeth associated with periapical pathology respond positively to vitality testing, the clinician should consider lesions of nonodontogenic origin in the differential diagnosis5,9,26 (Table 3). Pontes et al9
Conclusion
When evaluating and treating lesions of suspected endodontic disease, oral health care professionals must comprehensively evaluate all factors related to health history, hereditary risk, and thorough clinical examination to achieve an accurate differential diagnosis. Regardless of clinical presentation, one should always consider a nonodontogenic etiology until proven otherwise. Atypical testing and unresolved lesions recalcitrant to conventional treatments should prompt the need for additional
CRediT authorship contribution statement
Joseph A. Shilkofski: Conceptualization, Visualization, Methodology, Data curation, Writing - original draft, Writing - review & editing. Osman A. Khan: Conceptualization, Visualization, Writing - original draft, Writing - review & editing, Validation. Nader K. Salib: Supervision, Writing - review & editing, Data curation.
Acknowledgments
The authors deny any conflicts of interest related to this study.
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