Abstract
CLINICAL PRESENTATION A 26-year-old white man came to the dental clinic with a complaint of rapid, progressive loosening of his upper teeth. Clinical examination showed Class III mobility in the right posterior maxillary teeth, without detectable mucosal or alveolar abnormalities. Periapical radiographs demonstrated irregular bone around the roots of the maxillary right second and third molars (Fig 1), a feature that was not apparent from bite-wing radiographs taken during a routine dental exam 1 month before his current presentation. Although the clinical course and radiographic findings were considered unusual, a working diagnosis of rapidly progressive adult-onset periodontitis was made, and the patient was appointed for extraction of the right maxillary second and third molars. The extractions were accomplished without difficulty; however, no hard or soft tissue was submitted for histopathologic examination. A follow-up appointment 1 week later showed normal postoperative healing. Two months after the extractions, the patient presented with right maxillary and left periorbital swelling, as well as complaints of decreased left visual acuity, jaw pain, and fever. Left-sided proptosis and decreased function of
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