Epulis Fissuratum

Epulis fissuratum, also known as denture-induced fibrous hyperplasia, is a benign hyperplastic fibrous tissue reaction that occurs in response to chronic irritation caused by poorly fitting dentures. It commonly presents as a painless, soft, and pinkish-red swelling of the oral mucosa, usually in the vestibule of the mouth.

The condition is more common in older adults who wear removable partial or complete dentures, and women are more commonly affected than men. The severity of the condition varies from mild, asymptomatic forms to more severe, painful forms that can cause difficulty in eating, speaking, or wearing dentures.

Causes

Epulis fissuratum is a benign, fibrous growth that develops on the gum tissues due to chronic irritation from ill-fitting dentures or other dental appliances. The main causes of epulis fissuratum are:

1. Poorly fitting dentures: When dentures are not properly fitted, they can cause constant rubbing or pressure on the gums, leading to the formation of epulis fissuratum.
2. Chronic irritation: Other dental appliances such as partial dentures, braces, or retainers can also cause chronic irritation to the gums, leading to the development of epulis fissuratum.
3. Poor oral hygiene: Poor oral hygiene can lead to the accumulation of food particles and bacteria in the gums, causing inflammation and irritation, which can lead to the development of epulis fissuratum.
4. Smoking: Smoking can also cause chronic irritation to the gums, leading to the formation of epulis fissuratum.
5. Trauma: Trauma to the gums, such as accidental injury or biting down on hard objects, can cause epulis fissuratum to develop.
6. Hormonal changes: Hormonal changes during pregnancy or menopause can also lead to the development of epulis fissuratum.

In summary, the main causes of epulis fissuratum are poorly fitting dental appliances, chronic irritation, poor oral hygiene, smoking, trauma, and hormonal changes.

Symptoms

It is commonly seen in the gingival sulcus and is caused by ill-fitting dental prostheses, mainly complete dentures. The main symptoms of Epulis fissuratum include:

1. Swelling: The most common symptom is swelling of the gums, which may be localized or generalized. The swelling is usually painless and may be mistaken for an abscess.
2. Pain: Pain is not a common symptom of Epulis fissuratum, but if the lesion becomes infected, it may cause pain and discomfort.
3. Redness: The gums may appear red and inflamed, especially around the site of the lesion.
4. Ulceration: In severe cases, the lesion may become ulcerated, leading to bleeding and pain.
5. Difficulty in eating: As the lesion grows, it may interfere with chewing and cause discomfort while eating.
6. Halitosis: Halitosis or bad breath is also a common symptom of Epulis fissuratum, mainly due to the presence of bacterial infection.

In conclusion, Epulis fissuratum is a common oral lesion that usually presents with painless swelling of the gums, redness, and occasionally, ulceration. It is essential to seek medical attention if the symptoms persist or worsen.

Diagnosis

It occurs as a result of the mechanical pressure of an ill-fitting denture on the oral mucosa, leading to the formation of a localized mass of fibrous connective tissue.

The diagnosis of epulis fissuratum can be made through a comprehensive clinical examination and histopathological evaluation of a biopsy sample. The main diagnostic test is the biopsy, which involves the removal of a small tissue sample from the affected area for microscopic examination. This helps to determine the underlying cause of the lesion and rule out other possible oral pathologies such as oral cancer.

During the biopsy, a local anesthetic is used to numb the affected area, and a small incision is made to remove a small tissue sample. The sample is then sent to a laboratory for analysis, and the results are used to confirm the diagnosis.

Other diagnostic tests may include radiographic imaging such as a panoramic X-ray, which can help to visualize any underlying bony changes or other dental abnormalities that may be contributing to the lesion.

Overall, early diagnosis and treatment of epulis fissuratum is essential to prevent further complications and improve the patient’s quality of life. Treatment may involve the removal of the denture and the lesion, along with adjustments to the denture’s fit to prevent further irritation. In severe cases, surgical excision may be required, and the patient may need to be fitted with a new denture.

Treatment

Epulis fissuratum is a benign hyperplastic growth of the oral mucosa caused by chronic irritation from ill-fitting dentures or other dental appliances. The main treatment for epulis fissuratum is surgical excision, which involves the removal of the excess tissue to eliminate the source of irritation.

Before surgery, the dentist or oral surgeon may recommend antibiotic therapy to control any infection and reduce the risk of post-operative complications. Pain relievers and anti-inflammatory medications may also be prescribed to alleviate discomfort and swelling.

During the surgical procedure, the dentist will use local anesthesia to numb the affected area and make an incision to remove the excess tissue. The wound is then closed with sutures, and the patient is advised to follow post-operative instructions, such as avoiding hard or spicy foods and practicing good oral hygiene to prevent infection.

In some cases, if the underlying cause of the irritation is not addressed, epulis fissuratum may recur. Therefore, it is important for patients to maintain regular dental checkups and replace ill-fitting dentures or other dental appliances to prevent the condition from reoccurring.

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