Epulis
Epulis | |
---|---|
Specialty | Oral medicine |
Epulis (
Epulis fissuratum
This is a fibrous hyperplasia of excess connective tissue folds that takes place in reaction to chronic trauma from an ill fitting denture. It usually occurs in the mandibular labial sulcus. The clinical appearance of these lesions can vary, from erythematous mucosa that is prone to bleeding (a manifestation of hyperaemia), to lesions of more dense connective tissue, appearing more pale and firm.[6] Sometimes the term epulis is used synonymously with epulis fissuratum,[2] but this is technically incorrect as several other lesions could be described as epulides.
This condition typically affects middle-aged and elderly patients. It is causes when a denture irritates the mucosa forming an ulcer. In time, this ulcer may develop into an elongated fibro-epithelial enlargement. Several leaflets may develop.[7]
Management of this condition includes trimming the denture flange or areas causing irritation to the mucosa. Should modification of the denture not cause the lesion to decrease in size after 2–3 weeks, the swelling should be biopsied and examined histologically.[7]
Pyogenic granuloma
This type of epulis is neither pyogenic ("pus producing") nor a true granuloma, but it is a vascular lesion. About 75% of all pyogenic granulomas occur on the gingiva,[2] growing beneath the gingival margin,[8] although they may also occur elsewhere in the mouth or other parts of the body (where the term epulis is inappropriate). This common oral lesion is thought to be a reaction to recurrent trauma or a response to non-specific infection.[9] It is more common in younger people and in females, and appears as a red-purple nodular swelling and bleeds easily. Small lesions can vary from a few millimetres up to two or three centimetres. Larger lesions can be attached to the gingiva with or without a stalk.[10] This type of epulis may also penetrate interdentally and present as bilobular, i.e. present both buccally and lingually.[8]
Pregnancy epulis
Also termed a "pregnancy tumor" or "granuloma gravidarum",[2] this lesion is identical to a pyogenic granuloma in all respects apart from the fact that it occurs exclusively in pregnant females.[3] Hormonal changes during pregnancy causes an increased inflammatory response to plaque and other irritants, which in turn causes the development of the epulis.[9] There is usually pregnancy gingivitis also.[3] Pregnancy epulis commonly occurs during the third trimester of pregnancy.[11]
Fibrous epulis
In adults, this type of epulis is characterised as a firm, pink mass that is not inflamed. It seems to grow from below the free gingival margin/interdental papilla.
Ossifying fibroid epulis
Not to be confused with
Giant cell epulis
This epulis contains giant cells and is usually found on the gum margin between teeth which are anterior to the permanent molars.[13]: 317 The development of a giant cell epulis may be related to the recent loss of baby teeth, extraction or trauma.[13]: 319 The swelling is round, soft and commonly maroon or purplish in colour.[13]: 317 It is also termed peripheral giant cell granuloma. Children are typically mainly affected, with females being affected more than males[16]
Diagnosis of giant cell epulis usually requires a biopsy and radiographs should be taken of the area.[17]
Epulis granulomatosa
An epulis granulomatosa is a granuloma which grows from an extraction socket (the hole left after a tooth has been removed), and as such can be considered to be a complication of healing after oral surgery.[18]
Congenital epulis
This rare epulis (also called granular cell tumor, congenital gingival granular cell tumor or Neumann's tumor) presents at birth, and is not acquired,[19] in contrast to most other epulides which tend to be reactive lesions to tissue irritation. Congenital epulides mainly affect females and every so often, the growth is so large that it can obstruct breathing and feeding.[13]: 322 On rare occasion, it may arise on the tongue, or be multifocal.
Clinically, congenital epuli are usually found on the alveolar ridge, and are typically pink, pedunculated, firm, have a smooth or lobulated surface and the size varies from a few to 9 mm. They are usually found in solitary with multiple growths only in 10% of cases. It is commonly a pedunculated lesion in the incisor region. A diagnoses can usually be made based on clinical findings.[20]
Histologically, congenital epuli are benign and thought to have a mesenchymal origin. When examined, cells with abundant granular eosinophilic and small eccentric nuclei are found. A delicate fibrovascular network can be found between the cells. It has an unusual resemblance to granular cell myoblastoma and is more common in the maxilla than the mandible.[21]
A congenital Epulis can potentially involute, therefore, if it is not interfering with feeding and breathing, monitoring the lesion is advised. Otherwise, the lesion is removed with a simple excision and it does not have a tendency to recur.[20] Diagnosis is typically based upon clinical features but a biopsy confirms this.[22]
References
- ISBN 978-0-7216-2921-6.
- ^ ISBN 978-0721690032.
- ^ ISBN 978-0443071065.
- Perseus Project.
- ISBN 978-1-4377-0416-7.
- PMID 4591192.
- ^ a b Scully, Crispian (1999). Handbook of Oral Disease. London: Martin Dunitz. pp. 120–121.
- ^ PMID 26380825.
- ^ ISBN 9780199679850.
- ISBN 9789350908501.
- PMID 12362490.
- ISBN 9783642367137.
- ^ ISBN 9780702040016.
- ^ Scully, Crispian (1999). Handbook of Oral Disease. London: Martin Dunitz. p. 285.
- PMID 19414975.
- ^ Scully, Crispian (1999). Handbook of Oral Disease. London: Martin Dunitz. p. 286.
- ^ Scully, Crispian (1999). Handbook of Oral Disease. Martin Dunitz Ltd. p. 287.
- PMID 9693538.
- PMID 19262247.
- ^ S2CID 6828136.
- PMID 20130770.
- ^ Scully, Crispian (1999). Handbook of Oral Disease. London: Martin Dunitz. p. 280.