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Mark Bornfeld, DDS
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 5995
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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I have a small, rock hard, painless lump on my gum. Help

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I have a small, rock-hard, painless lump on my gum. It's on the inside face of my bottom row of teeth, right about between my left bicuspid and canine. It's about half way between the top of my gum line and the floor of my mouth. It's not fixed to my teeth/roots; I can move it around a little bit. It's maybe about as big as a drop of water. It's been here since late December, or at least that's when I first noticed it. It might be getting a little bit bigger, but it's hard to say. It's got an unbroken surface, there's no pus or anything.

I'm not sure if it's related, but I have a lymph node on my neck on my left side up by the jaw that's been swollen and painful (but not tender). This has been going on since mid January. It's not hard. I also have a low level sore throat all the time, and that's located only on the left side of my throat. Given it's position, I'm 90% sure that the sore throat is due to the swollen lymph node. If I press on the lymph node, I can make the sore throat worse. I saw a doctor about it in January, she gave me some antibiotics and when those didn't do anything basically said she had no idea and to come back in if it gets worse. She also took some blood and said my liver and kidneys were fine. I'm HIV negative but my white blood cell count was a bit low. I was a heavy smoker and drinker from about 16 to 21. I'm 23 now. I quit smoking about 6 months ago and I cut back on drinking about 2 years ago. I still drink sometimes, but it's not even a weekly occurrence, and when I do drink it's generally a glass of wine with dinner. I'm currently taking wellbutrin. I'm male and I'm a vegetarian. I have no family history of anything but gout and heart problems.

Welcome, and thank you for putting your trust in me!
Would you be able to provide a photograph of the involved area? You may use the "paper clip" icon on the text entry form toolbar to upload a digital picture. Alternatively, you may send your picture to a photo hosting site, such as Flickr or Photobucket, and provide a link to the picture in a reply to this information request. This will allow me to provide a more accurate and relevant response.

Customer: replied 3 years ago.

I don't think so. It's on the inner side of my teeth/gums. I'd need some sort of mirror set-up that I don't have.

In the absence of diagnostic information, there are several potential diagnoses that are suggested by your description.
The first and most likely is a normal anatomic variant known as a "torus mandibularis". This is suggested by the location, and your characterization of the lump as being "rock hard". The consistency implied by that descriptor could only represent a growth of bone, because the hardest bone or epithelial-derived lesions do not begin to approach that level of hardness. Where your description begins to part company with a torus mandibularis is your report that you "...can move it around a little bit", because tori are fixed to the mandibular bone, and are immovable. Because of this, some additional factor would seem to apply. In the case of mandibular tori, scrapes and cuts are common, because the gum tissue overlying them tend to be thin and often sustain friction with food during chewing activity. Therefore, a torus with perhaps some local tissue trauma would be my first guess. Torus mandibularis does not require treatment unless its presence interferes with the placement of a denture, in which case it may be surgically re-contoured. You can see a picture of torus mandibularis here:

Rarely, a fistula from a nearby tooth infection can drain to the gum surface in this area, but most fistulae are neither hard nor painless, and I include this for the sake of appearance. Other lesions that should be considered, although much less common, are epithelial neoplasms such as papillomas or keratoacanthomas, as well as granulomatous or infectious lesions (sarcoid, tuberculosis, or chancre). Malignancy would be very uncommon in this particular area, although salivary gland neoplasms do have some precedent here.
It is unlikely that your sore throat or lymph node are related to the lesion unless it represents infection; the lymph nodes in the neck do tend to become enlarged and tender in the presence of dental infection.
Hope this helps.

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