Differential Diagnosis for 37-year-old Male Smoker
- Single most likely diagnosis
- Periodontal abscess: The patient's symptoms of discomfort on the inside mid gum line with a small hard lump, along with a history of not visiting the dentist in over 5 years, suggest a dental infection such as a periodontal abscess. The associated symptoms of nasal congestion and swollen lymph nodes in the neck further support this diagnosis, as they can be indicative of a localized infection.
- Other Likely diagnoses
- Dental caries or tooth abscess: Given the patient's lack of dental care, dental caries or a tooth abscess are possible causes of his symptoms. These conditions can lead to localized pain, swelling, and potentially systemic symptoms like swollen lymph nodes.
- Gingivitis or periodontitis: These are chronic dental conditions that could cause discomfort and swelling in the gum line, especially in someone who hasn't received regular dental care. The presence of a small hard lump could be indicative of a localized infection or abscess formation.
- Pericoronitis: If the patient has a partially erupted wisdom tooth, pericoronitis (inflammation of the tissue surrounding the crown of a partially erupted tooth) could be a possible diagnosis, especially if the lump is near a wisdom tooth.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ludwig's angina: Although less likely, Ludwig's angina is a severe infection of the tissues in the neck that can cause significant swelling and potentially life-threatening airway obstruction. It requires immediate medical attention.
- Oral cancer: Given the patient's smoking history, oral cancer is a possibility, although less likely given the acute onset of symptoms. However, any unusual oral lesions or lumps, especially in smokers, warrant further investigation.
- Rare diagnoses
- Staphylococcal or other bacterial infections: Rarely, infections like staphylococcal infections could cause localized abscesses or swellings in the oral cavity, though these would typically be accompanied by more systemic signs of infection.
- Salivary gland stones or infections: While less common, stones or infections in the salivary glands could cause swelling and discomfort in the facial or neck area, potentially mimicking some of the patient's symptoms.