Zoom 100% – Visual Examination Findings

Visible observations:

• Localized firm swelling (hard lump) on the gingiva beside an upper posterior tooth

• Surrounding gum tissue shows signs of chronic inflammation

• Tooth involved appears discolored with an old/temporary restoration

• Gingival margin irregular with visible periodontal pocketing

• No obvious pus drainage seen at rest, but tissue looks chronically irritated

Client History (Highly Relevant)

• Lump present since February (long duration)

• Becoming harder and slightly larger

• Vertical sides feel bone-like

• Tender when firm pressure is applied

• History of:

  • Severe toothache

  • Cold sensitivity progressing to constant pain

  • Temporary filling placed (June last year)

  • Diagnosed gum disease with deep pockets

  • Food trapping consistently in the area

Most Likely Diagnoses (Ranked)

1. Chronic Periapical Abscess with Bone Involvement (MOST LIKELY)

Why:

• History of deep decay and unresolved tooth infection

• Temporary filling left long-term

• Hard swelling suggests bone reaction or chronic infection

• Tender on pressure, not acute pain → chronic phase

 Infection may be draining slowly or encapsulated, forming a firm mass.

2. Periodontal Abscess / Localized Advanced Periodontitis

Why:

• Documented deep periodontal pocket

• Food impaction

• Gum disease history

• Abscesses from periodontal origin often feel firm initially

3. Reactive Bone Growth (Exostosis / Localized Bone Response)

Why (less likely but possible):

• Hard, bone-like consistency

• However, tenderness and history of infection make this secondary, not primary

4. Dental Cyst (Radicular or Periodontal)

Why to consider:

• Long-standing lesion

• Progressive growth

• Often painless until advanced

 Requires X-ray or CBCT for confirmation.

Is the Lump Related to the Tooth with Temporary Filling?

✅ Yes – Very likely

• Temporary fillings are not designed for long-term use

• Bacteria may still be present in the pulp or root

• Infection can migrate into:

  • Bone

  • Periodontal tissues

  • Surrounding gum

Recommended Diagnostic Process

Immediate Steps

1. Periapical X-ray or CBCT scan

2. Periodontal probing to measure pocket depth

3. Pulp vitality testing

4. Clinical palpation and percussion test

Treatment Options (Depends on Diagnosis)

If Tooth Is Restorable

• Root Canal Treatment

• Permanent restoration or crown

• Periodontal deep cleaning (SRP)

If Tooth Is Not Restorable

• Tooth extraction

• Drainage of infection

• Bone debridement if needed

If Periodontal Origin

• Deep scaling and root planing

• Local antibiotics

• Possible periodontal surgery

Time Frame to Heal

 14 days is realistic for soft tissue comfort, but bone healing takes longer.

If Left Untreated – What Will Scale Up

• Spread of infection into jawbone

• Facial swelling

• Sinus involvement (upper teeth)

• Tooth loss

• Bone destruction

• Systemic infection risk (rare but serious)

Professional Comments

• A hard gum lump lasting months is NOT normal

• Temporary fillings should never be left long-term

• Chronic dental infections often become painless but destructive

• Early intervention prevents surgery and bone loss

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