(TC39) Osteosarcoma Mimicking Necrotic Pulp and Acute Apical Abscess: A Case Report

More commonly found in long bones, osteosarcoma of the jaw is rare, with an incidence of less than 1 case in 1.5 million persons per year.  It is slightly more common in males, affects the mandible more commonly than the maxilla, and has a mean age of incidence of 35 years.  The symptoms most common found with osteosarcoma of the jaw are pain and swelling.  Tooth mobility and parasthesia may be present.  It has also been reported that malignant neoplasms can cut off circulation to the tooth leading to pulpal necrosis.  Radiographically, early changes consist of localized widening of the periodontal ligament space, and more advanced lesions can appear as moth-eaten radiolucencies or as poorly marginated radiopacities.  Another radiographic characteristic of this lesion is a “sunburst” radiopaque appearance of the periosteum.  The purpose of this table clinic is to present a case of osteosarcoma mimicking a tooth with a necrotic pulp and acute apical abscess.  The clinical symptoms, radiographic findings, diagnostic difficulties, and treatment steps taken will be described.  The case will highlight similarities in presenting symptoms between osteosarcoma of the jaw and necrotic pulp with acute apical abscess.  Differentiating indicators will also be discussed.  With this knowledge, the clinician will be better able to recognize similar scenarios, identify appropriate next steps when treatment is non-responsive, and understand the importance of biopsy.