Unexplained Tooth Loosening Malignancy — ORE Part 1 MCQ

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HardOral MedicineUnexplained Tooth Loosening MalignancyORE Part 1

A 55-year-old man presents with progressive loosening of several mandibular teeth within one quadrant over 6 weeks. The teeth are vital and there is no plaque-associated attachment loss or periodontal pocketing. A periapical radiograph shows an ill-defined radiolucent area with loss of the normal trabecular pattern around the affected roots. Which diagnosis is the most important to exclude?

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Correct answer: A — An intraosseous malignant lesion

The correct answer is A. Rapid, localised mobility of vital teeth without periodontal pocketing or attachment loss, accompanied by an ill-defined destructive radiolucency, is not typical of routine periodontal or periapical disease. An intraosseous malignant lesion must therefore be excluded urgently. Relevant causes include metastatic carcinoma, lymphoma and plasma-cell malignancy such as multiple myeloma; mandibular myeloma can present initially as an osteolytic radiolucency. A localised periodontal lesion should have supporting plaque-related attachment loss and pocketing. A periapical inflammatory lesion is usually associated with pulpal infection or non-vitality and is centred at the root apex. Developmental enamel defects and physiological bone loss do not cause focal destructive bone loss with rapidly progressive tooth mobility.

Reference: Mohan RPS, Gill N, Verma S, et al. A multilocular radiolucency of mandible as the first evidence of multiple myeloma: A clinico-radiographic case report. Dent Res J (Isfahan). 2014. https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer