Several entities were included in the differential diagnosis of a large, firm, nontender swelling of the right posterior side of the mandible in a 56-year-old woman. A large, solid, destructive inflammatory tumor of the mandible is described. Several pathologic entities are considered and subsequently eliminated in the differential diagnosis. Purists may prefer a more general term, inflammatory pseudotumor, for this lesion because pulp testing procedures to rule out dental granuloma were never performed. Nevertheless, we strongly believe that the lesion described is a dental granuloma. A previously reported, similar case is mentioned. Although that lesion was entitled differently, we think that it, too, may have been a large residual dental granuloma. Several entities were included in the differential diagnosis of a large, firm, nontender swelling of the right posterior side of the mandible in a 56-year-old woman. A large, solid, destructive inflammatory tumor of the mandible is described. Several pathologic entities are considered and subsequently eliminated in the differential diagnosis. Purists may prefer a more general term, inflammatory pseudotumor, for this lesion because pulp testing procedures to rule out dental granuloma were never performed. Nevertheless, we strongly believe that the lesion described is a dental granuloma. A previously reported, similar case is mentioned. Although that lesion was entitled differently, we think that it, too, may have been a large residual dental granuloma.