Pathology · patient case question
What is the diagnosis of the gingival nodule?
Patient case: A swelling on the gum
Patient: Male, 29 years old
Chief Complaint: “A bump keeps coming and going on my gum, and it tastes bad when it drains.”
Background: Healthy. No pain currently — he had severe pain three weeks ago that stopped on its own.
Findings: A soft, yellowish-red nodule on the attached gingiva at the apex of a heavily restored mandibular first molar. Expressing it produces pus. The tooth does not respond to cold or electric pulp testing. A periapical radiolucency is present at the mesial root.
Show answer and explanation
Correct answer: D. Parulis (gum boil)
- A. A peripheral ossifying fibroma is a firm, often pale interdental papillary mass containing mineralised material; it is not fluctuant and does not discharge.
- B. A gingival abscess is confined to the marginal or interdental gingiva, arises from a foreign body forced into the sulcus, and involves a VITAL tooth with no periapical radiolucency.
- C. A pyogenic granuloma is a red, highly vascular, easily bleeding mass arising from local irritation or hormonal change; it does not drain pus and does not arise from a non-vital tooth.
- D. CORRECT. A PARULIS is the soft tissue opening of a sinus tract draining a chronic periapical abscess. The story fits it exactly: severe pain that ceased when the pulp died and the pressure found an exit, a non-responsive tooth, a periapical radiolucency, and a nodule that expresses pus and recurs. Treatment is directed at the CAUSE — root canal therapy or extraction — not at excising the nodule, which resolves on its own once the source is eliminated.