Which clinical features are typical for a periapical granuloma or cyst?

• A. Mild to no pain, minimal sensitivity to thermal stimuli and pressure
• B. Profuse bleeding on percussion
• C. Severe spontaneous pain and warmth on palpation
• D. Ulceration of overlying mucosa

Answer: (A)

Periapical granuloma and periapical cyst come from a chronic, low-grade inflammatory process at the tooth apex after the pulp dies. Because it progresses slowly, most patients experience little or no pain, and the tooth often remains nonvital. Clinically, there is minimal sensitivity to thermal stimuli and little tenderness to percussion or palpation; the lesion may be discovered on routine radiographs rather than through acute symptoms.

This is in contrast to conditions that cause a lot of pain: severe spontaneous pain with warmth on palpation points to an acute infection or abscess, not a chronic granuloma or cyst. Profuse bleeding on percussion would be unusual for these lesions, and ulceration of the overlying mucosa isn’t a typical feature of a simple periapical granuloma or cyst.