Case #1 Exam


	Mrs. Smith’s vital signs are stable, she is afebrile, and she has no unusual physical findings other than a slight swelling visible along the left border of her mandible, approximately midbody.


	On intraoral examination, Ms. Smith exhibits no unusual pain to percussion or palpation of any teeth. She says she has some discomfort, pointing to her left mandibular premolar/first molar region. In the left mandibular quadrant, Ms. Smith has a 3-unit fixed bridge from first premolar to first molar and her second molar has a mesioccclusal and buccal amalgam restorations. No carious lesions are noted. Periodontal probing depths are all 4 mm or less.


	Upon retraction of the left lower lip, swelling in the vestibule is obvious. The mass feels rubbery and slightly mobile. Palpation of the mass is uncomfortable for Mrs. Smith, but not acutely painful. No erythema or sinus tract is noted, and there is no report of drainage or foul taste.

A radiograph reveals endodontic treatment of the left mandibular first premolar and first molar. The premolar also has a cast post and core. The first molar has a periapical radiolucency associated with the mesial and distal roots. The obturation of both first molar roots appears to be slightly short of ideal. The mental foramen appears to be located just inferior and posterior to the first premolar root tip



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	After considering the following questions, continue to the next page.


	*Well doctor, what does your differential diagnosis include?* *Do you have a working diagnosis? What is it?* *What would you tell Mrs. Smith at this point?* *How would you treat this?*


	Complaint


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