Fibrous Overgrowth Lesion Flashcards
Epulis
Localized chronic inflammatory gingival hyperplasia
Peripheral fibroma clinically
F>m
Site anterior to first molar
Same color as gingiva
Sessile or pedunculated
Histology of peripheral fibroma
- avascular highly collagenous fibrous hyperplasia with mature fibroblast
- stretched atrophic epithelium
- mild to mod chr.inflm.cell infiltration
- peripheral ossifying fibroma and peripheral odontogenic fibroma are types
Local factor induced generalised gingival hyperplasia factor that cause it in some patients and not in others
Keratinocyte growth factor
Genetic ggh names
Congenital macrogingivae
Hereditary gingival fibromatosis
Elephantiasis gingivae
How drugs cause ggh
Exaggerate effect of local factors on gingival CT
Stimulation of fibroblasts-t collagen fibers formation.
Risk of drug induced ggh is higher in
Children and adolescent
Drugs and different percentage of ggh
Phenytoin 50%
Cyclosporin 10to70%
Nefedipine
Hormonal ggh is also called …
Pregnancy gingivitis
Clinical features of ggh
-enlarged interdental papilla then progress to free and attached gingiva
- rolled margin and loss of stippling
-appear inflammed more than the Hereditary type
-max more than mand and facial >ling
But if ling. Affected it becomes larger than the buccal and cause distortion of palate contour
- divided into lobules by frenum
-never exceeds mucogingival junctions
-not painful as nerve don’t grow in it
May over grow to the extent of covering the crown and impairing lip closure
Special clinical features for Hereditary ggh
-early in life
- related to eruption of primary
-may cover all crown
-may delay eruption
- may be localised
And remain stable or extend to involve other segments or the entire upper or lower jaw
Symmetric enlargement that extend posterior and palatal
- may be associated with hypertrichosis hypothyroidism growth hormone deficiency mental retardation
H/P of all GGH
:
o Hyperplastic mass consists of:
Hypocellular hypovascular dense collagenous
tissue in which the collegen bundles are interfacing
appearing to run in all directions with various degrees
of chronic inf. cells.
Covering epithelium may be hyperplastic with long & thin rete ridges that extend deeply into CT.
o in some cases (hormonal changes)→ prominent capillaries
CT
(not hypovascular).
In leukemic enlargement mass infiltrated by malignant
immature WBC
o Inflamed lesions show † in vascularity & chronic Inflammatory cells.
Site of pyogenic granuloma
-75% In gingiva Ant >post Max>mand Facial >palatal Also in areas of trauma 25% Lower Lip Buccal mucosa Tongue
Clinical of pyogenic granuloma
Color consistency depending on the age Early red or purple & soft.
Old lesions pink color & firm.
- Bleeding tendency → bleeds easily because of its extreme vascularity.
- Painless.
4 Size-vary from small to large (few millimeters in size to several cm),
usually pedunculated but may be sessile. 6. Surface → smooth or lobulated or ulcerated.
Recurrence of pyogenic granuloma
- if not completely removed
- if local factor still found
- if injury re occured
Pregnancy tumor invidence
Begins to develop during first trimester and continues to increase in incidence t through 7th month
Names of fibroepithelial polyp
Focal fibrous hyperplasia
Irritation fibroma
Traumatic fibroma
Cowden syndrome
- oral fibromas (fibroepi polyp)
- papillomas
- breast tumors
- thyroid tumors
Fibro epi polyp site
Areas of trauma
Buccal along occlusal plane
Lower lip
Tongue
Fibroepithelial polyp clinical
Signs & symptoms:
- Color-pink or lighter than normal due to reduction in vascularity (Occasionally, the color is whitish due to frictional keratosis as a result of the continuous exposure to irritant).
- Consistency firm.
- Less bleeding tendency.
- Painless.
- Size-varies from a few mm to one cm or more in diameter.
- Surface smooth or ulcerated if traumatized.
- Shape → sessile or pedunculated.
Talk about keratosis
Chronic inflm cells
Collagen of fibro epi polyp
- may be hyper k with chronic low grade friction
- perivasc – diffuse – or subepithelial
- vollagen is interlacing and in weavy course
Names of epulis fissuratum
Denture induced fibrous hyperplasia
Denture epulis
Inflammatory fibrous hyperplasia
Epulis fissuratum signes and symptoms
Age middle age and older adults.
- Sex-females > males.
- Site:
Depth of vestibule & lingual sulcus.
Mandible> maxilla.
Anterior> posterior.
> Facial aspects of alveolar ridge > lingual aspects. It may involve the inner surface of the lip, cheeks, palate along the posterior edge of the
denture (PPS).
- Size from localized lesion <1 Cm to massive lesions,
- Single or multiple fold or folds of hyperplastic tissue. 6. Mainly two folds with fissure where the overextended flange fit.
- Painless but may be painful if the base of the fissure is ulcerated due to trauma from the overextended flange.
- Consistency usually firm.
- Color mainly pink or lighter than normal but some lesions may appear
erythematous
- Surface may show areas of inflammatory papillary hyperplasia.
Cause of leaf like denture fibroma
- minor trauma from ill fitted denture
Clinical features of leaf fibroma that you forget
Size mm to 1cm or more
Attachment peduncylated
Percentage of people with inflm papillary hyperplasia wear denture 24h?
20%
Clinical of inflammatory papillary hyperplasia
- Site mainly on the palatal vault beneath the denture rarely on alveolar
ridges and palate inclines. 2. Usually asymptomatic lesion.
3.
Multiple papillary projections that are tightly aggregated producing an
overall pebbled or cobble stone appearance. Each projection is rounded, blunted.
4.
- Surface papillary surface which is rarely ulcerated.
Color & Consistency Erythematous & soft edematous. (7) May be associated with candidal infection (chronic atrophic candidiasis).
Treatment of inflammatory papillary hyperplasia
Treatment:
> Early lesion → removal of denture may | erythema and edema → tissue returns to normal appearance. o Improvement may occur after topical or systemic antifungal therapy. Advanced cases →→→ excision of hyperplastic tissue before new denture is made.
