For the patient above (mealtime swelling of a submandibular gland), which examination best confirms the suspected diagnosis?

Correct answer: B. Mandibular occlusal radiograph of the floor of the mouth

• A. Blood work does not localize or confirm a salivary stone; it would only be relevant if you suspected systemic infection.
• B. Correct. A mandibular occlusal (cross-sectional) radiograph projected at the floor of the mouth is the classic, inexpensive view to reveal a radiopaque submandibular sialolith in Wharton's duct. (Note: if the working diagnosis were instead a thyroglossal duct cyst, ULTRASOUND would be the confirming study — not an occlusal film.)
• C. A panoramic film can sometimes show a stone but superimposes structures and is far less sensitive than an occlusal view for floor-of-mouth calculi.
• D. Vitality testing assesses pulp status of teeth and has nothing to do with a salivary duct stone.

Note: See the flag on the previous question — the occlusal-radiograph option is what ties this case to a submandibular stone rather than a thyroglossal duct cyst.