A case of well-differentiated squamous cell carcinoma in an extraction socket
A 29-year-old female reported to the Department of Periodontics of M.A. Rangoonwala College of Dental Sciences and Research Centre, in the month of January 2010, with a complaint of pain and bleeding gums in the right side of the lower jaw since 1.5 months. A detailed case history revealed that the pain started 8 days following extraction of a mobile tooth in the same region. The pain was localized and continuous in nature. She experienced difficulty during mastication and while brushing. The pain also disturbed her sleep. The pain was only transiently relieved on taking analgesics. The patient complained of bleeding on and off from the extraction site. The patient also complained of halitosis. On receiving no permanent relief despite repeated visits to her dentist, she approached M.A. Rangoonwala Dental College for her problem.\nHer past medical history didn’t reveal anything of significance. The patient gave a history of use of mishri (a roasted, powdered preparation made by baking tobacco on a hot metal plate until it is uniformly black and later on powdered)[] 4-5 times a day for the past 15 years. The patient would place the quid of mishri in the vestibule on the right side. She cleaned her teeth once-a-day with a toothbrush and toothpaste but had stopped brushing following the onset of pain after the extraction.\nGeneral examination revealed that the patient was of moderate height and built, and her vital signs were within the normal range. She, however, had pallor.\nExtra-oral examination revealed a diffuse swelling along the lower border of the mandible on the right side extending from the angle of the mandible to the lip commissure. The overlying skin appeared normal with no sinus or color changes or temperature changes. The swelling overall was soft and tender on palpation, except in the submandibular region where it was indurated. The swelling didn’t exhibit any bruit or egg-shell crackling. The patient had partial trismus with mouth opening of 2.5 – 3.0 cms.\nIntra-oral examination revealed an ulcero-proliferative reddish pink colored growth measuring 2.5×1.5 cms. in the alveolar socket of extracted 46 [Figures and ]. The gingiva in relation to 45, 46, 47 appeared reddish-pink, edematous, and swollen. The intra-socket growth was soft in consistency and extremely tender and bled on the slightest provocation. 47 was grade I mobile, and pus exudation was seen from mesial aspect of 47. A white non-scrapable patch was seen on the right buccal mucosa in the premolar- molar region. The patch extended inferiorly into the vestibule and involved the attached gingiva. The surface was wrinkled and irregular with diffuse margins. There was no difficulty in the movements of the tongue.\nA provisional diagnosis of Alveolar osteitis was arrived at with the differential diagnosis including:\nOsteomyelitis Carcinoma of the alveolus.