History of the present illness

This is an 83-year-old black female who presented to the emergency clinic at Harborview Medical Center with gingival swelling and pain in the left posterior mandibular alveolar ridge between teeth #s 18 and 20; tooth # 19 was missing (Figure 1).  The patient stated that the area was painful, especially when biting down.  The area had been sensitive for several weeks and had been swollen for a few months.  The panoramic radiograph showed ill-defined radiolucency in the area of missing tooth #19 (Figure 2).  The swelling measured 2 x 2 centimeters with 1.5-cm height.   There was no history of tobacco or alcohol use. 

Figure 1 Photograph taken at first clinical presentation to Harborview Medical Center. Note the pink, sessile swelling between teeth #s 18 & 20. Tooth # 19 is missing. The mucosa is intact and shows no evidence of ulceration.