A 5-year-old patient's parent reports that tooth E (upper right primary canine) fell out recently. On examination, a small raised bump is seen on the gingiva near tooth F (upper right primary first molar). What does this bump MOST likely represent?

Correct answer: D. A parulis (gingival sinus tract/fistula) from a periapical abscess of tooth F

• A. Permanent tooth eruption presents as the tooth itself breaking through the mucosa, not as a raised bump remote from the tooth.
• B. A ranula is a mucocele from the sublingual salivary gland on the floor of the mouth — not on the labial or buccal gingiva.
• C. A traumatic fibroma is a firm, sessile, pink nodule from chronic mechanical irritation — it does not form acutely after tooth loss.
• D. CORRECT. A parulis is a raised, reddish nodule on the gingiva that represents the external opening of a draining sinus tract (fistula) from a periapical/furcation abscess in a primary tooth. In a 5-year-old, a bump adjacent to a primary molar after adjacent tooth loss suggests chronic periapical disease of the primary molar. Tooth F may have deep caries or a pulp-involved lesion that has formed an abscess and sinus tract.