The diagnosis of oral granulomatous lesions raises many challenges for the clinician. This article, which includes a case report, describes a process to formulate differential diagnoses by identifying distinguishing characteristics of an entity and applying that information to attain understanding of the ongoing pathophysiological process. Relevant clinical, radiographic, and histologic findings of common disease entities that can mimic clinical and radiographic presentation of this case are discussed to aid dental clinicians in identifying and diagnosing similar lesions in their practice.