Chapter 8 Soames Oral mucosa

Question 1

Essential feature of chronic inflammation is?

Answer 1

Processes of inflammation and repair occur simultaneously and the production of granulation tissue

Question 2

Most hyperplasias of the oral mucosa represent ?

Answer 2

Exuberant production of granulation tissue in chronic inflammatory reactions.

Question 3

Histological appearance of hyperplasias of oral mucosa

Answer 3

Spectrum change varying from chronically inflamed, richly cellular granulation tissue to relatively non-inflamed and avascular masses of dense collagen.

Question 4

What are epulis?

Answer 4

Localized hyperplasias of oral mucosa can arise anywhere in the mouth, but those arising from the gingiva usually receive this term.

Question 5

Describe the term epulis further

Answer 5

The term is non-specific and literally means ‘on the gum’, by common usage it implies a localized chronic inflammatory hyperplasia of the gingiva.

Question 6

When is the exception of using epulis as a term

Answer 6

Rare congenital epulis of the newborn.

Question 7

What are epulides?

Answer 7

Common localized tumour-like gingival enlargements but are hyperplastic and not neoplastic lesions.

Question 8

Where do epulides arise from?

Answer 8

Interdental tissues.

Question 9

Main aetiological factors of epulides

Answer 9

Trauma and chronic irritation, particularly from subgingival plaque and calculus.

Question 10

List localized hyperplastic lesions of the oral mucosa

Answer 10

• Epulides: fibrous epulis; pyogenic granuloma & pregnancy epulis (vascular epulides); peripheral giant cell granuloma (giant cell epulis)
• Pyogenic granuloma
• Fibroepithelial polyp
• Denture irritation hyperplasia
• Papillary hyperplasia of the palate

Question 11

What is the most common localized hyperplastic lesion of the oral mucosa?

Answer 11

• Fibrous epulis is the commonest, accounting for over half the cases, followed by the vascular types.

Question 12

How common is the peripheral giant cell granuloma?

Answer 12

Relatively uncommon, and accounts for about only 10 per cent of epulides.

Question 13

The localized hyperplastic lesions share which common clinical features?

Answer 13

• All more common in females than males, particularly so in the case of vascular lesions
• 80 percent occur anterior to the molar teeth
• Over half of the lesions present in the intercanine area
• Slightly more common in the maxilla than the mandible

Question 14

Which lesions recur more often?

Answer 14

• Particularly in the case of the peripheral giant cell granuloma, if the lesion has not been completely excised in the first instance

Question 15

How does fibrous epulis present as?

Answer 15

Pedunculated or sessile mass which is usually of firm consistency and of similar colour to the adjacent gingiva, although this will depend on the degree of vascularity and inflammation within the lesion.

Question 16

If fibrous epulis is ulcerated, what will it be covered by?

Answer 16

Yellowish fibrinous exudate.

Question 17

The epulis occurs over a wide age range but most arise between?

Answer 17

11 and 40 years of age

Question 18

Histologically, fibrous epulis usually comprises of?

Answer 18

Varying amounts of richly cellular fibroblastic granulation tissue and interlacing bundles of mature collagen fibres.

There is a variable inflammatory cell infiltration, predominantly of plasma cells.

Question 19

What sort of deposits are found within the fibroblastic tissue (in about one-third of cases) , particularly if there is ulceration of the covering stratified squamous epithelium?

Answer 19

Amorphous deposits of calcification and/or trabeculae of metaplastic bone are found

Question 20

Is there a reason to regard epulides as a distinct entity?

Answer 20

No, and the presence or absence of calcification does not affect their clinical behaviour.

Question 21

Less commonly, the lesion consists of _________ identical to the fibroepithelial polyp.

Answer 21

Dense relatively avascular fibrous tissue

Question 22

Pyogenic granuloma and pregnancy epulis present as ?

Answer 22

Rather soft, deep reddish-purple swellings, which are often extensively ulcerated.

Question 23

Haemorrhage in vascular epulides may occur?

Answer 23

May occur either spontaneously or on minor trauma. The distinction between the lesions is purely clinical.

Question 24

Histologically, vascular epulides and the pregnancy epulis is regarded as ?

Answer 24

Pyogenic granuloma occurring in a pregnant female.