History of the present illness

This is a 27-year-old white male who presented with less than a year history of a lesion in the posterior mandible with symptoms of pain, gingival swelling, and ulceration around teeth #s 29-31. The patient was aware of the symptoms for only a few months. The gingiva around these teeth was grey-purple and showed extensive recession (Figure 1). The panoramic radiographic findings (Figure 2) notably show extensive bone loss with the appearance of teeth “floating in space.” He was treated with Amoxicillin and Flagy to no avail. Recent bone scan showed a small lesion in the right rib and possibly some very small lesions in the skull.


Figure 1 Photograph taken at first clinical presentation. Note the severe periodontitis with gingival recession involving teeth #s 29-31


Figure 2 Panoramic radiograph taken at first clinical presentation. Note the sharply demarcated lytic lesion of teeth #s 29-31 giving the impression of teeth “floating” in space.e