swellings Flashcards
Fibroepithelial polyps def
A soft tissue inflammatory swelling, caused by chronic trauma or low grade infection, characterised by hyperplasia of the epithelium
Denture induced hyperplasia/leaf fibroma
Denture induced fibrous lesion which forms under a denture due to chronic irritation or trauma and becomes flattened against the palate
Histology of Fibroepithelial polyps
- Hyperplastic epithelium
- Elongation of rete ridges in epithelum
- Dense fibrous tissue replacing vascular
- Chronic inflammatory cells in connective tissue
Clinical features of fibroepithelial polyps
- site: buccal mucosa, lip, tongue
- size: variable
- shape: pedunculate usually or sessile
- single or multiple: usually single
- symptoms: painless unless traumatised
- color: mucosal colored
- base: firm and movable, and smooth
Fibroepithelial polyps DDx
- Pyogenic granuloma (usually red until later stages it gets more fibrous)
- Squamous cell papilloma (HPV 6&11)
- Neuroma
- Mucocele
- Verruca vulgaris (white exophytic growth caused by smokeless tobacco)
Fibroepithelial polyps Tx
- Excisional biopsy (less than 1 cm)
- remove source of irritation and trauma
Pyogenic granuloma def
a soft tissue inflammatory swelling, caused by chronic irritation and low grade infection, its rapidly growing, red and vascular overgrowth made of granulation tissue
If pyogenic granuloma in the gingiva
vascular epulis
where does pyogenic granuloma occur?
It can occur anywhere in the oral cavity: about 75% occurs on the
gingiva – vascular epulis.
Histology of pyogenic granuloma
- dilated blood vessels
- oedema in connective tissue
- fibroblasts
- chronic inflammatory cells
Clinical presentation of pyogenic granuloma
- size: variable
- site: most commonly the gingiva
- shape: rounded and well defined, sessile or pedunculate
- single or multiple: usually solitary
- symptoms: Painless, but may become tender or bleed easily with minor trauma
- color: Red to dark purple due to high vascularity.
*Younger lesions are more red and vascular so bleed easily
*Mature lesions become more pink and fibrous as vascularity decreases - base: smooth or lobulated surface
- palpation: soft but not movable (not fluctuant)
Pyogenic granuloma Tx
- excisional biopsy (less than 1 cm)
- remove causative factors
- improve OH and PMPR of adjacent teeth
Pyogenic granuloma DDx
- giant cell epulis
- fibroepithelial polyp (mucosal colored, firm and rubbery)
- haemangioma (vascular, sometimes blanches)
- kaposi sarcoma (HHV associated with HIV)
Epulis def
a general term used to describe a number of reactive gingival lesions with vascular, fibroblastic and granulation tissue proliferation.
Aetiology epulis
Chronic injury or low grade infection
Epulis prevelance
30-50y
Female predilection
Types of epulis
- fibrous epulis
- vascular epulis (pyogenic granuloma)
- pregnancy epulis
- giant cell epulis
fibrous epulis
a reactive gingival swelling, characteristed by fibrous hyperplasia of the tissues
Types of fibrous epulis
- fibroepithelial polyp in the gingiva
- denture induced hyperplasia (epulis fissuratum)
Characteristics of fibrous epulis
- mucosa colored (pink)
- firm and movable
- common between anterior teeth
- mostl commonly sessile if in the gingiva
- usually painless
Epulis fissuratum
Aka denture induced hyperplasia
Epulis fissuratum = denture induced hyperplasia
Clinical presentation of epulis fissuratum
- A smooth pink surfaced lump parallel with alveolar ridge.
- Sometimes grooved or ulcerated by denture flange/
- Several leaflets with fairly firm consistency may develop
Tx epulis fissuratum
- relive denture flange and monitor to see if regresses
- if it doesnt regress within 2-3 weeks excise lump for histological assessment
