Clinical  and Radiographic Findings

The clinical examination revealed numerous nodules on the head and neck area, including the oral cavity (Figure 1).  The nodules were smooth-surfaced and were of variable shape and size.  In the oral cavity the nodules involved the buccal mucosa, lips and palate.   

Figure 1.  Multiple nodules on the lips and buccal mucosa.  Also notice the gingival hyperplasia at the edentulous left maxilla.

Hyperplasia of the gingiva at the left maxilla was associated with irregular-looking alveolar bone (Figure 2).  The patient had three impacted teeth: #s 1, 17 and 32.  Teeth #s 17 and 32 demonstrated dentigerous cyst with irregular bone overlying the dentigerous cysts.  The alveolar nerve canal was slightly widened at the right side .  Most of the remaining teeth demonstrated secondary caries.

Figure 2. Panoramic view at first presentation demonstrating many failing restorations, three impacted teeth, irregular bone structures at the left maxilla and mild expansion of the inferior alveolar canal at the right side of the mandible.