Pathology · single question
An African American female, 44 years old, with Type 2 diabetes and a 10 pack-year smoking history presents. Mandibular incisors respond normally to cold testing. There is no pain and no evidence of caries. A periapical lesion is noted on tooth 26. What is the best treatment option?
Show answer and explanation
Correct answer: A. Monitor the lesion on tooth 26
An African American female with a vital tooth (responds to cold), no caries, no pain, and a periapical radiolucency is the classic presentation of PERIAPICAL CEMENTO-OSSEOUS DYSPLASIA (PCOD). PCOD is a benign reactive fibro-osseous lesion that occurs predominantly in African American women in the mandibular anterior region. The affected teeth remain vital. No treatment is needed — MONITORING is the appropriate management. RCT on a vital, asymptomatic tooth would be incorrect.
- A. CORRECT. The clinical presentation (vital tooth, African American woman, mandibular anterior region, radiolucency, no symptoms) is pathognomonic for periapical cemento-osseous dysplasia (PCOD). Treatment = MONITOR. No intervention needed.
- B. INCORRECT. Extraction is not indicated for a vital, asymptomatic tooth with PCOD — this would destroy a healthy tooth.
- C. INCORRECT. Apicoectomy is a surgical endodontic procedure for cases where conventional RCT has failed or cannot be done. It is inappropriate for a vital tooth with PCOD.
- D. INCORRECT. Root canal treatment is contraindicated here — the tooth is VITAL (responds to cold). There is no pulpal pathology. Performing unnecessary RCT on a vital tooth would be inappropriate.