Lumps and Bumps

Question 1

What is an epulis

Answer 1

A lesion that occurs on the gum only.

Question 2

What are the main characteristics of common lesions found on the gums?

Answer 2

Non-neoplastic, hyperplastic, caused by trauma or chronic irritation (e.g., subgingival plaque and calculus), and may recur.

Question 3

What are the three categories of gum lesions?

Answer 3

Developmental, reactive, and neoplastic.

Question 4

What is a fibrous epulis?

Answer 4

A fibrous mass limited to one region of the gum.

Question 5

What are the clinical features of a fibrous epulis?

Answer 5

• Wide range of ages (11-40y)
• Pedunculated (stalk)/sessile (broad base attached to gingiva) mass
• Firm, surface may be ulcerated
• Might contain metaplastic bone
• Colour similar to rest of gingiva

Question 6

What is the treatment for fibrous epulis?

Answer 6

Surgical excision.

Question 7

What is a vascular epulis?

Answer 7

• Soft, deep red/purple swelling
• Haemorrhage is common – may bleed if probed
• Anytime during pregnancy
• Blanches with soft pressure

Question 8

What is the relationship between vascular epulis and pregnancy?

Answer 8

It is also called pregnancy epulis or pyogenic granuloma, and its size may decrease after delivery.

Question 9

What is a giant cell epulis?

Answer 9

A lesion also known as peripheral giant cell granuloma (PGCG), occurring in soft tissue, usually anterior to molar teeth.

Question 10

What is the difference between PGCG and central giant cell granuloma (CGCG)?

Answer 10

PGCG is in soft tissue, while CGCG is inside the jawbone and requires an x-ray for diagnosis because histology similar

Question 11

Giant cell epulis clinically

Answer 11

• Average age 30-40y
• Anterior to molar teeth
• Slightly more common in mandible
• Pedunculated or sessile dark red mass

Question 12

What are the possible diagnoses for a giant cell lesion?

Answer 12

CGCG
giant cell tumor
cherubism
brown tumor (hyperparathyroidism brown due to haemosiderin )
aneurysmal bone cyst.

Question 13

What is a congenital epulis?

Answer 13

A rare neoplasm called congenital gingival granular cell tumor, not a true epulis.

Question 14

What is a fibro-epithelial polyp?

Answer 14

A focal fibrous hyperplasia that is not exclusive to the gingiva.

Question 15

Where do fibro-epithelial polyps most commonly occur?

Answer 15

On the cheeks (occlusal line), lips, and tongue.

Question 16

What is the clinical appearance of a fibro-epithelial polyp?

Answer 16

• Pink, painless, pedunculated or sessile polypoid swelling – same origin as epulis but not exclusive to gingiva
• ‘Leaf fibroma’ – flattened
• Once established, no size change, usually not ulcerated

Question 17

What is denture irritation hyperplasia (epulis fissuratum)?

Answer 17

Soft tissue folds in the vestibular sulcus related to the periphery of an ill-fitting denture.

Question 18

Denture irritation hyperplasia (epulis fissuratum) - Clinically

Answer 18

• ‘Leaf-like’ folds related to the periphery of an ill-fitting denture
• Usually firm, not very inflamed

Question 19

How is denture irritation hyperplasia managed?

Answer 19

Denture adjustment, new denture, and/or surgical excision.