Chapter 8 Soames Oral mucosa Flashcards
Essential feature of chronic inflammation is?
Processes of inflammation and repair occur simultaneously and the production of granulation tissue
Most hyperplasias of the oral mucosa represent ?
Exuberant production of granulation tissue in chronic inflammatory reactions.
Histological appearance of hyperplasias of oral mucosa
Spectrum change varying from chronically inflamed, richly cellular granulation tissue to relatively non-inflamed and avascular masses of dense collagen.
What are epulis?
Localized hyperplasias of oral mucosa can arise anywhere in the mouth, but those arising from the gingiva usually receive this term.
Describe the term epulis further
The term is non-specific and literally means ‘on the gum’, by common usage it implies a localized chronic inflammatory hyperplasia of the gingiva.
When is the exception of using epulis as a term
Rare congenital epulis of the newborn.
What are epulides?
Common localized tumour-like gingival enlargements but are hyperplastic and not neoplastic lesions.
Where do epulides arise from?
Interdental tissues.
Main aetiological factors of epulides
Trauma and chronic irritation, particularly from subgingival plaque and calculus.
List localized hyperplastic lesions of the oral mucosa
- 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
What is the most common localized hyperplastic lesion of the oral mucosa?
- Fibrous epulis is the commonest, accounting for over half the cases, followed by the vascular types.
How common is the peripheral giant cell granuloma?
Relatively uncommon, and accounts for about only 10 per cent of epulides.
The localized hyperplastic lesions share which common clinical features?
- 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
Which lesions recur more often?
- Particularly in the case of the peripheral giant cell granuloma, if the lesion has not been completely excised in the first instance
How does fibrous epulis present as?
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.
If fibrous epulis is ulcerated, what will it be covered by?
Yellowish fibrinous exudate.
The epulis occurs over a wide age range but most arise between?
11 and 40 years of age
Histologically, fibrous epulis usually comprises of?
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.
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?
Amorphous deposits of calcification and/or trabeculae of metaplastic bone are found
Is there a reason to regard epulides as a distinct entity?
No, and the presence or absence of calcification does not affect their clinical behaviour.
Less commonly, the lesion consists of _________ identical to the fibroepithelial polyp.
Dense relatively avascular fibrous tissue
Pyogenic granuloma and pregnancy epulis present as ?
Rather soft, deep reddish-purple swellings, which are often extensively ulcerated.
Haemorrhage in vascular epulides may occur?
May occur either spontaneously or on minor trauma. The distinction between the lesions is purely clinical.
Histologically, vascular epulides and the pregnancy epulis is regarded as ?
Pyogenic granuloma occurring in a pregnant female.
