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Epulides

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Definition and clinical picture

Gingival tissue overgrowth
(Celsus/Galen: "disease on the gingival surface"; Axhausen: "no epulis without a tooth")

These tumour-like lesions, designated as epulis, are rather:
  • Due to chronic trauma or inflammation
  • Usually of connective-tissue origin and only rarely of epithelial origin
  • Non-neoplastic

Classification
The epulis nomenclature described by Axhausen is rarely used in non-German speaking countries. The diseases referred to as epulides will be designated in this chapter using the current WHO classification (Wahi 1971).
(non-German-speaking countries)
Histopathological classification (Axhausen):
(German-speaking countries)
WHO classification
- Epulis granulomatosa → - Pyogenic granuloma
- Epulis fibromatosa → - Fibrous hyperplasia
- Epulis gigantocellularis → - Peripheral giant-cell granuloma
- Epulis fissurata → - Inflammatory fibrous dysplasia
- Epulis gravidarum → - Pyogenic granuloma

Note:
The term "epulis" should only be used for the clinical description of a localised gingival overgrowth where histological diagnoses including benign and malignant tumours cannot be excluded. After the diagnosis has been confirmed histopathologically, diseases that are designated as epulides should be referred to with the following terms:
- Pyogenic granuloma,
- Fibrous hyperplasia, or
- Peripheral giant-cell granuloma
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Pyogenic granuloma

Synonyms: Lobular capillary hemangioma, granulation tissue-like hemangioma, epulis granulomatosa, epulis gravidarum, granuloma teleangiectaticum, epulis angiomatos

Definition and clinical picture

Local reactive connective-tissue proliferation of skin and mucosa. Localised most frequently on the gingival surface or in the vestibule, the tongue, or the cheek. Women are more frequently affected than men. Marginal periodontitis is of causal significance in its aetiology; microtrauma is also a possible cause. Often a short case history and a tendency for recurrence.
Special form: Pyogenic granuloma (Epulis gravidarum)

Morphology

- Broad-based or pedicled red overgrowth with a diameter of a few millimetres to 2 cm
- Frequently superficial ulceration or white coating
- Often bleed when touched

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Histology

Granulation tissue with various degrees of inflammation and development of collagen fibres. In case of prominent capillary proliferation: "Granuloma teleangiectaticum". Strictly speaking, they are not granulomas.

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Treatment

- Surgical removal with resection of periosteum and bone and the affected periodontal ligaments down to healthy tissue
- In case of relapse: Extraction of the adjacent tooth

Fibrous hyperplasia

Synonym: Epulis fibromatos

Definition and clinical picture

Polypoid, usually broad-based, rough, pale overgrowth of the gingival mucosa; pedicled forms also occur. Marginal periodontitis and microtrauma can also be significant in the aetiology.

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Special forms:
1. Inflammatory fibrous dysplasia
Localisation in the area of the denture flange, often multiple. The surface may be ulcerated. Aetiology: Ill-fitting denture; inflammation secondary to functional activity (speech and mastication).

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2. Traumatic fibromas
Ubiquitous in the oral cavity, often at the level of the occlusal plane. Broad-based or pedicled mucosal protrusion. Usually reactive, irritative, localised lesions; clinically and histologically similar to fibromas (true neoplasias)

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Histology

Polypoid protruding mucosa, subepithelial nodular and dense deposition of collagen fibre bundles with sparse small blood vessels, usually without inflammatory infiltrate.

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Treatment

Excision (and send for histological examination)
Improvement of the denture fit, if necessary

Peripheral giant-cell granuloma

Definition and clinical picture

Localised on the gingival margin as a dark-red to bluish "epulis"; only occurs on the gingiva; a non-neoplastic, localised, reactive cell proliferation with tendency for recurrence.

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Histology

Histologically analogous to what is referred to as central giant-cell granuloma (the designation of "peripheral" or "central" depends on their localisation: peripheral =on the gingiva, central =intra-osseous). Vascular connective tissue, mononucleated cells and multinucleated giant cells.

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Treatment

- Surgical removal with excision of the underlying periosteum and adjacent bone and affected parts of the periodontal ligaments of the teeth involved in the lesion
- In case of relapse: extraction of the tooth


sources

  • Axhausen, G. (1947)   Allgemeine Chirurgie in der Zahn- Mund- und Kieferheilkunde   Hanser, München
  • Horch, H. H. (o.J.)   Mund-Kiefer-Gesichtschirurgie 1   Praxis der Zahnheilkunde 10,1
  • Wahi PN, Cohen B, Luthra UK, Torloni H (1971)   Histological typing of oral and oropharyngeal tumours   International histological classification of tumours 7