Epulis: classification, clinicomorphological features, differential diagnostic
DOI:
https://doi.org/10.11603/2311-9624.2023.4.14495Keywords:
periodontal tissue, reactive hyperplastic lesions, fibrous epulis, pyogenic granuloma, epulis gravidarum, epulis fissuratumAbstract
Summary. Epulis is a clinical term called the tumor-like lesion of periodontal tissues. Currently, most researchers define epulis as a reactive proliferative lesion that result from persistent local irritation or mechanical damage to the gingiva. Also, the development of epulis is influenced by the level of female sex hormones, which can explain the occurrence of pyogenic granuloma (vascular epulis) in pregnant women.
The aim of the study – to determine the clinical and morphological criteria for differential diagnosis of various types of epulis.
Materials and Methods. For the period 2020–2023 15 patients with epulis were examined, of which 1 girl 16 years old and 14 adult women aged 21–84 years old. Among them, 5 women were on the III trimester of pregnancy and 2 women had denture-related fibroma (epulis fissuratum). Surgical removal of epulis and pathohistological study of excisional biopsy was performed in all patients.
Results and Discussion. It was found that epulis occurs mainly in young women (78.6 %), the average age of patients was 36.0±4.7 years (n = 15). Clinical results determined that epulis occurs more often on the maxilla (66.7 %) than on the mandible (33.3 %), with epulis localization on the maxilla predominantly around incisors and premolars, and on the mandible - around canines. Epulis can be small (up to 0.5 cm – 26.7 % of cases), medium size (0.6-2.0 cm – 53.3 %) and large size (more than 2 cm – 20 %), more often irregular shape. It was proved that the probable cause of epulis in 60.0 % of women was chronic trauma, in 33.4 % – hormonal changes, namely pregnancy. Histologically, pyogenic granuloma is more common (60% of cases) than fibrous epulis (40 %), which can be explained by the development of vascular epulis in pregnant women (epulis gravidarum). It was shown that for the purpose of differential diagnostic of epulis with other neoplasms of oral soft tissues, X-ray examination of teeth (jaws) in the site of tumor-like lesion and pathomorphological study of excision biopsy should be carried out.
Conclusions. For the epulis diagnostic, pathomorphological study is mandatory. Clarification of the histological type of epulis becomes the basis for determining treatment and preventive measures and tactics of follow-up of the patient in order to prevent recurrence of lesion.
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