Oral mucosa: benign neoplasms and reactive lesions Flashcards
TABLE IN LECTURE - RED MORE IMPORTANT
RED MORE IMPORTANT
Swellings of gingival tissues = Epulis/epulides - local causes?
Fibrous hyperplasia Pyogenic granuloma Peripheral giant cell granuloma Gingival cysts Bohns nodules
Swellings of gingival tissues = Epulis/epulides - generalised causes?
Chronic hyperplastic gingivitis - inflam Leukaemic infiltration Endocrine related (puberty, pregnancy) Crohn's disease Gingival fibromatosis Drug induced hyperplasia
Fibrous epulus features?
Same colour as oral mucosa
Firm
Painless unless traumatised
Caused by trauma - dentures, teeth, ortho apliances
Overgrowth of fibrous CT covered by hyperkeratinised SS epithelium
Fibrous epulus/fibro-epithelial polpy management?
Excision, remove cause
Send for histopathological examination
Pyogenic granuloma features?
Red/purple/blue vascular growth Sessile = flat base or pedunculated = on a stalk Rapid growth Soft, bleeds easily Usually <40yrs Common in pregnancy/puberty
Caused by trauma e.g. plaque, calculus, denture, ortho appliances
Overgrowth of very vascular granulation tissue = red colour
Pyogenic granuloma management?
Excision and remove cause
If pt pregnant improve OH and excise but may recur
Lesions may mature into dense fibrous tissue (fibrous epulis)
Also found at other sites in oral mucosa
Peripheral giant cell granuloma?
Soft red/blue sessile or pedunculated swelling
Usually anterior teeth, mandible>maxilla
Average age <40yrs
Similar to a pyogenic granuloma clinically
May cause superficial bone resorption
Only found on gingiva
Vascular fibrous tissue
Numerous multinucleate giant cells
Haemorrhage
Giant cell lesion on histology
Management of peripheral giant cell granuloma?
Important to determine whether lesion has arisen on gingiva or arisen within bone and burst through cortical plate. Radiographs - large radiolucency = central one
If arisen in bone = diff diagnosis = central giant cell granuloma and hyperparathyroidism
Excision. curettage of underlying bone to prevent recurrence and send lesion for histopathological examination
Bohn’s nodules and epstein pearls?
Usually in babies - will disappear on own, very rare
Differential diagnosis of epulides?
Firm, mucosa coloured = fibrous epulis
Soft, red, red/blue - pyogenic granuloma, giant cell granuloma
If pt pregnant/puberty then more likely pyogenic granuloma
Definitive diagnosis by excisional biopsy
Remember to exclude an abscess from tooth or gum- red/yellow/soft/fluctuant
How to know something is an abscess?
Adjacent to broken down tooth - looks yellow
Vitality testing and radiographs
Painful on pressure
Generalised gingival swellings?
Hereditary: Gingival fibromatosis
Inflammatory: Chronic hyperplastic gingivitis
Hormonal: Endocrine related (puberty, pregnancy)
Diet related: scurvy
Drug related: drug induced hyperplasia
Neoplastic - Leukaemic infiltration: Wegners granulomatosis
Associated with GI tract disease: Crohn’s disease
Gingival fibromatosis features?
Hereditary (Autosomal Dominant) Lifelong Pale pink, firm overgrowth May cover and submerge teeth May regrow after removal
Chronic hyperplastic gingivitis?
Associated with poor oral hygiene
Erythematous gingivae, BOP
Hormonal related gingival hyperplasia?
Puberty and pregnancy
Exaggerated response to plaque - OHI, will settle down once baby is born
Red, erythematous, bleeds easily on probing