Epulides

• Epulides?

  benign localised enlargement of the gingival tissue
• classification of True Epulides?

  • fibrous
  • vascular eg pregnancy, pyogenic granuloma
  • peripheral giant cell granuloma
• what might present as a epulides?

  • congenital epulis
  • fibroepithelial polp
  • denture-irriation hyperplasia
  • kaposi's sarcoma
  • haemangioma
  • chondrosarcoma
  • metastatic tumour
  • localised trauma
  • connectice tissue tumour
• epidemiology?

  • tumour like lesions of gingivae not neoplastic
  • localised gingival hyperplasia, fibrous/vascular/mixed
  • caused by chronic irritation of gingiva
  • classified by histological appearance
  • ulcerations, hyperkeratosis from secondary trauma
• aetiology?

  develop following trauma from subgingival plaque/calculus
• Fibrous Epulis clinical presentation

  • 10-40yrs
  • pink enlargement of ID gingiva
  • vascular when inflammed, no blanching, firm
  • ossification/calcification
• fibrous epulis - histological feature?

  • core highly cellular fibroblastic and granulation tissue
  • stratified squamous epithelium covering
  • may ulcerate
  • plasma cells and mature collagen
• treatment of fibrous epulis?

  • surgical excision and gingival recontouring
  • to confirm diagnosis tissue analysed histopathology
  • malignancy - incisional biopsy
  • deep scaling post-excision to remove cause
  • dressing applies and CHX post op
  • 7 day review, remove pack, pt careful OHI
• fibrous epulis

  
• pregnancy epulis histology?

  • core highly cellular fibroblastic and granulation tissue
  • stratified squamous epithelium covering
  • may ulcerate
  • plasma cells and mature collagen
• pregnancy epulis aka?

  vasular epulis
• pregnancy epulis

  
• clinical presentation of vascular epulis?

  • anterior, labially
  • soft, pedunculated with narrow base
  • enlarge throughout gestation period
  • red, granular surface prone to haemorrhage
  • ulcerate?
  • if large aesthetic/functional issue
  • subgingival calculus
  • can recur after excision
• vascular epulis

  
• vascular epulis

  
• vascular epulis

  
• histopathology of vascular epulis?

  • mass of vascular space, fine, delicate
  • layers of solid endothelium
  • thin-walled vessels
  • surface ulceration and underlying inflammatory infiltrate
  • repair by granulation tissue formation
• vascular epulis

  
• vascular epulis

  
• tx vascular epulis?

  • intenvie ohi
  • excision - good vasocontrictor
  • pressure dressing
  • may return
• peripheral giant cell granuloma?

  • 30-40 years
  • anterior mouth and mandible
  • more common in females
• clinical presentation of peripheral giant cell granuloma?

  • pedunculated or sessile lesion
  • dar red, surface ulcerations
  • hourglass shape
  • radiograph always, bone involvment
  • cause erosion of bone cortex
  • excision essential
• histopathology of giant cell granuloma?

  • collections of osteoclast-like giant cells
  • varying giant cells and numbers
  • stoma cells = spindle like
  • macrophages contain phagocytosed haemosiderin
  • may have bony trabeculae within
• peripheral giant cell granuloma

  
• peripheral giant cell granuloma

  
• peripheral giant cell granuloma

  
• tx of peripheral giant cell granuloma?

  • complete excision and PMPR
  • involving bone - curette bone wall
• sessile - broad attachment

  pedunculated - stalk like
• denture-irritation hyperplasia?

  • localised enlargement due to irritants clasps/acrylic
  • sessile or pedunculated
  • ulcerated surface or hyperkeratotic
  • removing cause will resolve lesion
• denture irritation hyperplasia

  
• denture irritation hyperplasia

  
• denture irritation hyperplasia

  
• fibroepithelial polyp

  • allong occlusal plane
  • chronic irritation - sole cause
  • buccal musoca, lateral border of tongue or lips
  • rare on gingiva
  • fibrous tissue core, acellular
• fibroepithelial polp

  
• kaposi's sarcoma

  
• kaposi's sarcoma?

  • oral lesions, 50% in HIV infection