A 41-year-old female visited a dentist for a checkup. Radiographic examination revealed a cluster of small radiopacities superimposed over the ramus of the mandible.
Joen Iannucci Haring, DDS, MS
The patient denied any pain or dental problems and appeared to be in a general good state of health. The patient`s only significant past medical history included hospitalizations for kidney stones. The patient`s past dental history included sporadic dental examinations and routine restorative and periodontal treatment. At the time of the dental appointment, the patient was taking Seldane® for seasonal allergies.
The patient`s blood pressure was recorded at 110/70, and all other vital signs were found to be within normal limits. Examination of the head and neck region revealed no enlarged or palpable lymph nodes. No significant extraoral findings were noted. Examination of the oral soft tissues revealed no unusual findings.
After a thorough clinical examination, a panoramic radiograph along with selected bite-wing and periapical films were ordered and exposed. Examination of the panoramic radiograph revealed the presence of multiple small, irregular-shaped radiopacities superimposed over the left mandibular ramus (see radiograph).
No bony expansion was noted in the area of the ramus, and no additional radiopacities were noted on other areas of the panoramic film. The radiopacities were not visible on the periapical or bite-wing radiographs.
Based on the clinical and radiographic information presented, which of the following is the most likely diagnosis?
- sclerotic bone
- calcified lymph nodes
As the term suggests, a tonsillolith is a small stone-like calcification found in the palatine tonsils [lith is from the word "lithos" (Greek) meaning stone]. Tonsilloliths are formed in tonsillar crypts that are responsible for the entrapment of desquamated epithelium, bacteria and food debris. Over time, the trapped organic debris mineralizes. Typically, tonsilloliths are associated with recurrent tonsillar infections and persistent sore throats.
Although tonsilloliths are typically seen in young adults, these structures may be identified in any age group. Males and females are affected equally. Tonsilloliths may be asymptomatic, or the patient may complain of a persistent throat irritation and foul taste. Long-standing tonsilloliths may cause pain, abscess formation, dysphagia, or bad breath.
Tonsilloliths may occur singly or in multiples and may be identified in one or both tonsils. The size may vary from several millimeters to several centimeters in diameter. Larger tonsilloliths may be clinically evident and appear as a yellow-white hard mass in the affected tonsil.
Joen Iannucci Haring, DDS, MS, is an associate professor of clinical dentistry, Section of Primary Care, The Ohio State University College of Dentistry.