Epulides

Question 1

What are epulides?

Answer 1

Epulides are benign localised enlargements of the gingival tissues

Question 2

Classification of epulides?

Answer 2

True epulides:
1. Fibrous epulis +- calcification
2. Vascular epulis (pregnancy or pyogenic)
3. Peripheral giant cell granuloma (or central)

Question 3

What are some lesions presenting as epulides but are not true epulis?

Answer 3

o Congenital epulis
o Fibroepithelial polyp
o Denture-irritation hyperplasia
o Kaposi’s sarcoma – vascular tumour you get in AIDS
o Haemangioma
o Chondrosarcoma
o Metastatic tumours, eg renal metastases
o Localised trauma, eg during flossing
o Connective tissue tumours

Question 4

What are the aetiologies of epulides?

Answer 4

Develops following trauma from subgingival plaque/calculus
(chronic irritation of gingival tissues)

Question 5

What is the clinical presentation of fibrous epulis?

Answer 5

Pink enlargement of interdental gingivae
Presents between 10-40yrs
Sessile or pedunculated
More vascular when inflamed (so will bleed)
Normally firm with no blanching
Ossifying/calcification can occur

Question 6

What can a fibrous epulis turn into if it calcifies and what is the relevance of this?

Answer 6

Calcifying/cementifying fibrous epulis
Relevance: higher likelihood of returning if this occurs
Take a radiograph for this

Question 7

How do we treat fibrous epulis?

Answer 7

Surgical excision and gingival re-contouring
Tissue MUST go to histopathology to confirm diagnosis
(where malignancy is suspected, incisional biopsy)
Deep scaling post-excision is essential to remove cause
Periodontal dressing should be applied as pressure pack
Prescribe CHX for immediate post-operative period (if too sore to brush)
At 7 day review, remove pack and careful prophylaxis
Patient resumes careful interproximal plaque control. Give OHI

Question 8

What is the clinical presentation of a vascular epulis?

Answer 8

Usually anterior and labial in the mouth
Soft, pedunculated lesion with a narrow base
Red, granular surface prone to haemorrhage
Surface may ulcerate (fibrinous surface) through trauma
Can become very large –> aesthetic and functional problems
Associated with subgingival plaque/calculus

Question 9

Are vascular epulises likely to recur following excision?

Answer 9

Recurrence following exicision is common

Question 10

How do we manage pregnancy epulis?

Answer 10

During pregnancy, they can enlarge throughout gestation period
Generally defer surgical management until after birth

Question 11

If you were given this image, how would you describe it?

Answer 11

Not epulis straight away. Incisors and premolars with provisional temporary restorations of questionable quality. Query cleanability of them (gingival margin should be kept clear of). Might be a plaque trap causing inflammation or the gingival tissues, may potentially leading to a clinical presentation of epulis. To be sure, take an incisional biopsy to send to histopathology for a report. Potential other diagnoses would be … and list.

Question 12

How do we treat vascular epulis?

Answer 12

Intensive OHI and scaling under LA
If excision necessary, good vasoconstriction is vital
Electrocautery/diathermy should be to hand
Use pressure dressing (pink stuff press it on)
May return, so excision normally preferred post-partum

Question 13

What LA do we use for scaling/removal of vascular epulis and why?

Answer 13

Lidocaine
Want the LA with the most vasoconstrictor in it as it will reduce vascularity and may help resolve it

Question 14

When does PGCG usually occur?

Answer 14

Between 30-40, occasionally very young or very old
Females>males 2:1

Question 15

What is the clinical presentation of peripheral giant cell granuloma?

Answer 15

Pedunculated or sessile lesion
Dark red in colour, may have surface ulceration
May be ‘hour-glass’ in shape from palatal to buccal surface
May cause erosion of bone cortex

Question 16

Should we radiograph a PGCG and why?

Answer 16

ALWAYS RADIOGRAPH ANY EPULIS!
They may arise centrally in bone
Want to know if there is subgingival calculus
Want to know if there is calcification or bone within it, since it is more likely to recur and needs cutting off multiple times

Question 17

How do we come to a diagnosis of PGCG?

Answer 17

Radiograph and incisional biopsy

Question 18

What is tx for a PGCG?

Answer 18

Following accurate diagnosis:
Complete excision necessary followed by scaling where necessary
If lesion involves bone, curette bone well
(lesion will bleed a lot, needs to be managed)

Question 19

Describe denture-irritation hyperplasia?

Answer 19

Associated with outline of the denture
Localised enlargement due to irritant clasp/acrylic
Sessile or pedunculated
Surface may be ulcerated or hyperkeratotis
Removal of cause should resolve lesion
Can be related to candida

Question 20

Describe fibroepithelial polyp

Answer 20

Usually along occlusal plane (usually from biting)
Chronic irritation is the sole cause (often denture)
Buccal mucosa, lateral border of tongue or lips (rare on gingivae)

Question 21

Describe Kaposi’s sarcoma

Answer 21

Oral lesions = 50% in HIV infection
Diagnosis is clinical and histopathological
Vascular tumour
(typically found on nose)

Question 22

What should be noted about the mucogingival junction and tumours?

Answer 22

SOMETHING THAT IS PLAQUE INDUCED WILL NOT EXTEND PAST THE MUCOGINGIVAL JUNCTION

Question 23

What are some exceedingly rare lesions that can present as epulides?

Answer 23

Haemangioma
Chondrosarcoma
Ameloblastic fibroma
Odontogenic carcinoma
Odontogenic sarcoma
Metastatic tumour (renal metastasis)

Question 24

Images of epulides vs sinister lesions

Answer 24