Mandibular radiolucencies – how to refer and manage appropriately

Radiolucencies may be detected in either the maxilla or mandible during routine examination and can arise from odontogenic or non odontogenic causes. A radiographic survey at primary care level may be limited to intra-oral periapicals owing to the lack of justification for dental panoramic tomograms (DPTs). The purpose of this paper is to discuss three different referrals of mandibular radiolucencies, which were investigated at Whipps Cross University Hospital, following referral from GDPs. The paper will explore the presentation, imaging and management of the cases.

A 46-year-old lady was referred by her dentist due to an unknown left mandible radiolucency, associated with mobility of her LL7. She was a smoker but medically fit. Extra-oral examination was unremarkable, and intra-orally there was a no bony expansion or swelling of the left mandible. There was no paraesthesia along the distribution of the inferior alveolar nerve. The LL7 was grade 1 mobile but responded positively to ethyl chloride testing. The DPT (Figure 1) revealed a well demarcated, wine goblet-shaped radiolucency in the left body of the mandible extending from the LL6 to LL8 region. It appeared to be intimately related to, and in continuity with, the left inferior alveolar canal. The roots of the LL6 and LL7 appeared resorbed, although there did not appear to be any significant periodontal disease-related bone loss around either LL6 or LL7.