Lung cancer is the most frequent cause of cancer-related deaths in the world. While metastases of
lung malignancies to the oral cavity are rare, lung cancer is the most common malignant neoplasm to metastasize to the head and neck region. Diagnosis of a metastatic lesion in the oral cavity is challenging for clinicians and pathologists alike, but is critical in improving patient outcomes. In our current report, we present a case of a 75 year old female. The patient received a diagnosis of lung adenocarcinoma metastatic to posterior left mandible. The lesion was initially thought to represent a periapical pathology associated with an endodontically involved tooth and has received root canal therapy without resolution of symptoms. We conducted a literature review of cases of lung cancer metastasis to the oral and maxillofacial region published between 2015 and 2022 and compared our findings with existing literature. Malignant non-endodontic lesions can present similarly to many benign lesions in the oral cavity, and early detection and biopsy of these lesions is critical to improving the prognosis of these cases.