Oral Pulse Granuloma: A Veiled Entity

A 65-year-old man reported to Department of Oral and Maxillofacial Surgery with a painful swelling over the left mandibular molar region and inability to open the mouth since one month. The patient gave history of pain since one and half month and noticed the swelling since 15 days. His general health was non-contributory and clinical examination revealed poor oral hygiene with fixed partial dentures, periodontitis and gingivitis. Intra-oral examination revealed smooth localized swelling in relation to tooth #36, which was grossly decayed with deep periodontal pocket involving furcation area with food debris and calculus. There was pain on palpation and percussion. Oral hygiene was poor with fixed partial dentures, gingivitis and periodontitis. A provisional diagnosis of chronic periodontal abscess was given and differential diagnoses of chronic periapical abscess/granuloma were considered. On radiographic examination Orthopantomograph (OPG) revealed periapical radiolucency pertaining to tooth #36 [Table/Fig-1]. With a clinical diagnosis of a chronic periapical abscess due to combined periodontic-endodontic involvement was considered. As the tooth was grossly decayed with furcation involvement, the patient was referred to the Department of Oral and Maxillofacial Surgery for extraction of tooth #36.