History of the present illness

This is a 13-year-old white male who presented for an emergency exam of a large swelling in the left posterior mandible and ramus area. The clinical examination revealed a palpable mass that was slightly painful and was described to have intermittent bleeding episodes. Teeth #s 18 & 19 were slightly mobile. Patient states the problem started shortly before the braces were placed and the problem became worse after the braces were placed. Panoramic radiograph showed an ill-defined radiolucency involving the posterior mandible (teeth #s 17-19) extending superiorly into the ramus (Figure 1). The past medical history is negative.

Figure 1 Panoramic radiograph taken at first clinical presentation. Note the ill-defined radiolucency in the posterior mandible extending superiorly into the ramus. Also note the bone loss around teeth #s 18 & 19.