Dentistry, like other fields of medicine, is characterized by the presence of many diseases. Quite often, people are bothered by unpleasant tumors in their mouth. These include epulis. To be more specific, epulis is a mushroom-shaped growth on the gum. The good news is that mostly it does not deliver severe pain(if the tumor is not malignant) and causes only aesthetic discomfort. It can occur in all people, children are no exception. Interestingly, it has been recorded that epulis occurs several times more often in women than in men.
Tumor formation mainly appears near the molars (premolars). The color of epulis is similar to the reddish tint of the gums. But sometimes the formation can acquire a bluish color.
The size of the mushroom-shaped epulis can vary. In a serious stage it can reach quite large sizes. The range is as follows: 2 mm - 3 cm in diameter. The tumor becomes very noticeable when talking, smiling or opening the mouth.
In appearance, epulis looks like an overgrowth of the gum itself. If we consider the tumor as a mushroom shape, then several features can be identified. From the outside, only his hat is visible. The stem of the epulis is attached to the tooth. Only a dentist can see these features.
The tumor may be hard to the touch, or, on the contrary, it may be too soft.
If epulis was acquired as a result of injury from a prosthesis, filling, or the edge of a tooth, then an ulcer often forms on its surface.
Types of epulis
- Angiomatous epulis. This species mainly affects children 5-10 years old and adolescents under 18. Epulis is located mainly at the neck of the tooth. Visually, the tumor has a bright red color (due to the presence of many blood vessels) and rough surface. The base of the tumor itself is wide. When touched, angiomatous epulis is soft and can quickly begin to bleed. This tumor is growing quite quickly. After removal it usually appears again.
- Fibrous epulis. The consistency of fibrous epulis is quite dense with a wide base. The color of this type of tumor is similar to the color of the gums. There is no bleeding. The formation grows slowly (the slowest of all types), but reaches large sizes. If you do X-ray, then you can see a round or oval seal on it. This type often occurs on the vestibular side of the gum.
- Giant cell epulis. An accurate diagnosis is established only after an x-ray. The image usually shows a clear outline where the destruction occurred bone tissue. This type of tumor grows very slowly. The color of epulis is mainly bluish-purple. It may bleed, but not often. This epulis most often affects patients 40-60 years old. In women, giant cell epulis is more common.
Malignant formation
The above types are typical for benign tumor. Malignant formation is characterized by the following characteristics:
- Fast growth.
- Quite a lot of swelling of the gums.
- Severe pain and sensitivity to touch.
- Whitish lesions.
- Destruction of root canals located near inflammation.
- Heavy bleeding.
- Ulcers.
- Cracks.
If this occurs, death may occur. But this is quite a rare occurrence for this reason. The most important thing here is to detect the problem in a timely manner. Mild forms of the disease are treated faster and more efficiently.
The final diagnosis is made by a doctor after clinical trials and conducting histological examination.
Causes of epulis on the gums
A tumor can appear in the oral cavity for various reasons:
- Severe and minor bruises.
- Improperly manufactured and installed dentures and wearing them without the necessary adjustment.
- Strong tartar.
- Malocclusion.
- A decayed tooth with sharp edges.
- Protruding and overhanging filling.
Course of the disease
Angiomatous epulis is common in children. But other types may also arise. The tumor is more common in girls than in boys. The disease usually affects young patients during teething. Why is this happening? Teething is accompanied by severe trauma to the gums and mucous membrane. The tumor grows greatly in the oral cavity and begins to seriously bother. The child’s parents need to seek help from a specialist as soon as possible. The faster help is provided, the easier the consequences will be.
In adolescents, epulis can also occur as a result of injury. Another reason is hormonal changes body. Most often, tumors occur during puberty. It can also occur as a result of taking inappropriate medications.
It’s interesting, but in children, one form of epulis often turns into another. For example, when granulomatous epulis occurs, this type eventually turns into angiomatous and then fibrous. This transition is observed in 14% of cases of the disease.
Due to hormonal imbalance or changes in the body, epulis occurs in pregnant women. If we add trauma to this, the tumor grows quite quickly.
Removal of epulis
Epulis gums are removed surgically. To do this, make an incision of approximately 2-3 mm and remove the formation. After removal, the edges are combined. The wound is covered on top with gauze, which is moistened in an iodoform mixture. Another option: a mucous flap is placed on the wound.
Removal of adjacent teeth is rarely resorted to. Basically only when they are excessively mobile and when the roots are strongly exposed. If the bone is severely affected or the disease has relapsed, then partial resection is performed. The teeth and alveolar part of the gums are affected. With this treatment, a positive outcome often occurs. If the operation is performed incorrectly, a relapse may occur.
The operation is performed under anesthesia. A high-quality procedure for removing epulis guarantees no consequences and rapid healing of the wound. Therefore, you need to be careful when choosing a good specialist.
Modern dentistry often uses lasers to carry out such interventions. In this case, infiltration anesthesia is usually performed. The advantage of using a laser is that it simultaneously eliminates (cauterizes) and disinfects the area. As a result, the rehabilitation period is reduced and complications practically do not arise.
To possible postoperative consequences include:
- Bleeding.
- Suppuration.
In all cases it is necessary urgent help specialist Treatment of such consequences is often carried out with the help of antibiotics and the use of rinses.
Folk remedies
Completely cure epulis on the gums folk remedies impossible. But do rehabilitation period lighter and shorter is completely possible. Healing will be much faster. The essence of treatment with folk remedies is to rinse with herbal decoctions. In practice, several recipes are used:
- First recipe. Calendula is used as the main ingredient. To prepare the decoction, you need to pour two tablespoons of the plant into a glass. hot water. Let stand until cool. During this time, the solution will gain the required concentration. For effective treatment you need to rinse your mouth 3-4 times until obvious relief occurs.
- Second recipe. The ingredients are sage, eucalyptus and chamomile. Dry herbs are mixed in equal proportions. To prepare the decoction, take two tablespoons of the resulting mixture and a glass of boiling water. The infusion time and number of rinses are the same as in the previous recipe.
- Third recipe. Baking soda helps prevent the appearance of inflammation and pus. The medicinal mixture is prepared as follows: in a glass clean water add a teaspoon of soda. You need to rinse 3-4 times.
- Fourth recipe. The composition is prepared using table salt. To do this, dissolve a spoonful of the substance in a glass of boiling water. The resulting solution relieves swelling well and prevents the growth of bacteria. Just use it after it has cooled completely.
Preventive actions
Prevention consists of regular oral hygiene. At the same time, you need to understand that due to hormonal disorders, the disease can still occur.
It is necessary to resort to sanitation of the oral cavity within the walls of the clinic. In addition to treatment, dentists will remove tartar and perform professional cleaning. If necessary, doctors will correct the bite, which also leads to the formation of epulis. As a result, the risk of tumors and other dental diseases is reduced significantly.
In addition to the above, it is very important to avoid gum injuries and promptly detect dental diseases.
Possible complications
Tumor removal is rarely accompanied by complications. But if such occur, then basically it is:
- New tumor growth in the old place (relapse).
- Heavy or light bleeding.
- Tissue suppuration (usually occurs due to the ingestion of various bacteria).
- Swelling after surgery.
In case of complications, follow these recommendations:
- Strictly monitor the sanitation of the oral cavity.
- Follow all doctor's recommendations.
- Take medications prescribed by a specialist.
Reviews
Ksenia, 36 years old, Moscow
I myself encountered epulis on my gums. It's an unpleasant thing. Finding the tumor seriously bothered me. I didn’t even immediately understand or realize her appearance. While it was being determined that this was an abnormal phenomenon, the tumor had reached a fairly large size. At the initial appointment at the clinic I was told that adjacent teeth are not damaged and will not be removed. Then I remember I sighed. The operation itself did not seem at all scary to me. It was performed with a laser under local anesthesia. There was a pregnant woman sitting on the bench next to me in line. I have a hard time understanding what kind of need it is to remove a tumor in its position. But maybe she had difficult situation, I was embarrassed to ask. After the operation I treated oral cavity ordinary soda solution. The wound healed quite quickly and stopped bothering me. All this happened to me more than 4.5 months ago. To my joy, to date, I have not had a relapse.
Karina, 33 years old, Moscow
My six-year-old son suffered from Epulis (he has an incorrect bite). We didn't discover the tumor right away. My son didn't complain. More precisely, the disease was discovered by the dentist during the next examination. We regularly go to the doctor before starting school year. I was unpleasantly surprised. I read a lot about epulis and realized that it is not a good thing. I was especially frightened by its possible malignancy. How this thing appeared in a small child is unclear. My son felt terrible before the operation (crying, afraid, screaming) and during the procedure. After the removal was completed, I conveyed to my son that if I do not rinse with special means, the tumor may reappear. Therefore, my son strictly followed all the recommendations. He even liked the procedures. And he himself began to remind me to rinse. As a result, we quickly improved. Now I watch his mouth more closely. We continue to rinse with folk remedies for prevention.
RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2015
Other specified changes in the gingiva and edentulous alveolar margin (K06.8)
Maxillofacial Surgery
general information
Short description
Recommended
Expert advice
RSE at the RVC "Republican Center"
healthcare development"
Ministry of Health
And social development
Republic of Kazakhstan
dated September 15, 2015
Protocol No. 9
Epulis- tumor-like lesion of the alveolar process of the jaws.
Protocol name: Epulis
Protocol code:
ICD-10 code(s):
K06.8 Other specified changes in the gingiva and edentulous alveolar margin.
Abbreviations used in the protocol:
AST - aspartate foreign ferase;
ALT - alanine aminotransferase;
CT - CT scan;
Exercise therapy - physiotherapy;
UAC - general blood analysis;
OAM - general urine analysis;
UHF - ultra high frequencies;
Ultrasound - ultrasonography;
Ural Federal District - ultraviolet irradiation;
ECG - electrocardiogram;
ECHOCG - Echocardiogram.
Date of development of the protocol: 2015
Protocol users: maxillofacial surgeons, oncologists.
Assessment of the degree of evidence of the recommendations provided.
Level of evidence scale:
| A | High-quality meta-analysis, systematic review of RCTs or large RCTs with very low probability (++) of bias results. |
| IN | High-quality (++) systematic review of cohort or case-control studies or high-quality (++) cohort or case-control studies with a very low risk of bias or RCTs with a low (+) risk of bias. |
| WITH | Cohort or case-control study or controlled trial without randomization with low risk of bias (+). |
| D | Case series or uncontrolled study or expert opinion. |
| GPP | Best Pharmaceutical Practices |
Classification
Clinical classification
:
· fibrous epulis;
angiomatous epulis;
Peripheral giant cell epulis.
Diagnostics
List of diagnostic measures:
Basic (mandatory) diagnostic examinations at the outpatient level:
· UAC;
X-ray of the jaws.
Minimum list of examinations that must be carried out when referred for planned hospitalization: according to the internal regulations of the hospital, taking into account the current order of the authorized body in the field of healthcare.
Basic (mandatory) diagnostic examinations carried out at the hospital level:
· UAC;
· OAM;
· Determination of blood group according to the ABO system using standard sera;
· Determination of the Rh factor of blood;
· Biochemical analysis blood (protein, bilirubin, ALT, AST, glucose, thymol test, urea, creatinine, residual nitrogen);
· histological examination(UD-D).
· coagulogram (PTI, prothrombin time, INR, fibrinogen, APTT, thrombin time, ethanol test, thrombotest).
Additional diagnostic examinations carried out at the hospital level:
· CT scan of the skull;
· CT scan of the jaws;
· determination of electrolytes: potassium, sodium, chlorides;
Diagnostic measures carried out at the stage of emergency care: No.
Diagnostic criteria for diagnosis:
Complaints and anamnesis:
Complaints:
· for the presence of formation in the oral cavity;
· dysfunction of eating, speech (for large sizes);
Bleeding due to injury.
Anamnesis:
· slow painless growth over several months.
Physical examination:
Fibrous form:
formation of a round or irregular shape, located on the vestibular side of the gum on a wide, less often narrow base (pedicle) and adjacent to the teeth, can spread through the interdental space to the oral side;
· covered with a mucous membrane of a pale pink color, has a smooth or lumpy surface, dense elastic consistency, painless, does not bleed.
Angiomatous form:
· located at the neck of the tooth;
· finely lumpy, less often smooth surface, bright red color with a cyanotic tint, relatively soft consistency.
· Bleeds even with slight injury.
Peripheral giant cell form:
painless round or oval formation;
· lumpy surface, soft or densely elastic consistency, bluish-purple color.
· located on the alveolar part of the jaw, bleeds.
· impressions from the antagonist teeth are visible.
· the teeth to which the epulis is attached shift and become loose.
Laboratory research:
· histological examination - proliferation of granulation tissue with predominance fibrous tissue; (with fibrous epulis)
proliferation of granulation tissue with a predominance of angiomatosis; - (with angiomatous epulis).
Instrumental studies:
X-ray of the jaws:
· fibrous form: resorption of the edge of the alveolar process;
· angiomatous: no changes;
· peripheral giant cell form: destruction of the cortical plate of the alveolar process of the jaw.
Indications for consultation with specialists:
· oncologist - to make a final diagnosis and draw up a treatment plan.
Differential diagnosis
Differential diagnosis
(UD-B):
| № | Nosology | Basic clinical differential diagnostic criteria |
| 1. | Hypertrophic gingivitis | Accompanied by spontaneous bleeding, sometimes with minor pain. The gingival papillae and gingival margin are not only hypertrophied, but also hyperemic. |
| 2. | Gingival polyp | has a denser consistency, bluish color, a shorter and wider stalk, and has less mobility. |
| 3. | Fibroma | Localized on the mucous membrane of the lips, cheeks, gums, soft palate, less often than the tongue, located on a wide base or on a thin stalk, has a round, less often nodular shape, covered with a pale pink mucous membrane. |
Treatment abroad
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Treatment
C
ate treatments:
· surgical removal neoplasms;
· restoration of bone tissue defect;
· restoration of functions.
Treatment tactics .
1. Clinical and x-ray examination;
2. Surgical treatment;
3. Drug treatment;
4. Preventive actions;
Not drug treatment:
· Mode - general.
· Diet - table No. 15.
Drug treatment:
| № | Drug, release forms | Dosing | Duration and purpose of use |
| Antibiotic prophylaxis | |||
| 1 |
Cefazolin powder for solution for injection 500 mg and 1000 mg |
1 g IV (children at the rate of 50 mg/kg once) | 1 time 30-60 minutes before the incision skin; at surgical operations lasting 2 hours or more - an additional 0.5-1 g during surgery and 0.5-1 g every 6-8 hours during the day after surgery to prevent inflammatory reactions |
| 2 |
Cefuroxime + Metronidazole Cefuroxime powder for solution for injection 750 mg and 1500 mg Metronidazole solution for infusion 0.5% - 100 ml |
Cefuroxime 1.5-2.5 g, IV (for children at the rate of 30 mg/kg once) + Metronidazole(for children at the rate of 20-30 mg/kg once) 500 mg i.v. |
in 1 hour to the cut. If the operation lasts more than 3 hours again after 6 and 12 hours similar doses, in order to prevent inflammatory reactions |
| If you are allergic to β-lactam antibiotics | |||
| 3 |
Vancomycin powder for solution for infusion 500 mg and 1000 mg |
1 g IV (for children at the rate of 10-15 mg/kg once) | 1 time 2 hours before the skin incision. No more than 10 mg/min is administered; the duration of infusion should be at least 60 minutes in order to prevent inflammatory reactions |
| Opioid analgesics | |||
| 4 |
Tramadol solution for injection 100mg/2ml 2 ml each, or 50 mg orally |
Adults and children over 12 years of age are administered intravenously (slow drip), intramuscularly at 50-100 mg (1-2 ml of solution). If there is no satisfactory effect, an additional administration of 50 mg (1 ml) of the drug is possible after 30-60 minutes. The frequency of administration is 1-4 times a day, depending on the severity pain syndrome and effectiveness of therapy. Maximum daily dose- 600 mg. Contraindicated in children under 12 years of age. |
|
| 5 | Trimeperidine injection solution 1% -1 ml |
1 ml of 1% solution is administered intravenously, intramuscularly, subcutaneously; if necessary, it can be repeated after 12-24 hours. Dosage for children over 2 years of age is 0.1 - 0.5 mg/kg body weight, if necessary, repeated administration of the drug is possible. |
for the purpose of pain relief in postoperative period, 1-3 days |
| Nonsteroidal anti-inflammatory drugs | |||
| 6 |
Ketoprofen injection solution 100 mg/2m - 2 ml, or 150 mg prolonged or 100 mg orally. |
the daily dose for IV is 200-300 mg (should not exceed 300 mg), then oral administration prolonged 150 mg 1 time per day or 100 mg 2 times per day |
The duration of treatment with IV should not exceed 48 hours. Duration general use should not exceed 5-7 days, with anti-inflammatory, antipyretic and analgesic purposes. |
| 7 |
Ibuprofen suspension for oral administration 100 mg/5 ml100ml; or 200 mg; orally, granules for oral solution 600 mg |
For adults and children over 12 years of age, ibuprofen is prescribed 200 mg 3-4 times a day. To achieve a rapid therapeutic effect in adults, the dose can be increased to 400 mg 3 times a day. Suspension - single dose is 5-10 mg/kg of the child’s body weight 3-4 times a day. The maximum daily dose should not exceed 30 mg per kg of body weight of the child per day. |
No more than 3 days as an antipyretic No more than 5 days as an anesthetic with anti-inflammatory, antipyretic and analgesic purposes. |
| 8 |
Paracetamol 200 mg, 500mg; oral suspension 120 mg/5 ml; or rectally 125 mg, 250 mg, 0.1 g |
Adults and children over 12 years of age weighing more than 40 kg: single dose - 500 mg - 1.0 g, 500 mg - 1.0 up to 4 times a day. The maximum single dose is 1.0 g. The interval between doses is at least 4 hours. The maximum daily dose is 4.0 g. Children from 6 to 12 years: single dose - 250 mg - 500 mg, 250 mg - 500 mg up to 3-4 times a day. The interval between doses is at least 4 hours. The maximum daily dose is 1.5 g - 2.0 g. |
The duration of treatment when used as an analgesic and as an antipyretic is no more than 3 days. |
| Hemostatic agents | |||
| 9 |
Etamzilat injection solution 12.5% - 2 ml |
4-6 ml of 12.5% solution per day. For children, a single dose of 0.5-2 ml is administered intravenously or intramuscularly, taking into account body weight (10-15 mg/kg). |
If there is a risk of postoperative bleeding, it is administered for prophylactic purposes. |
Other types of treatment:
Other types of treatment provided on an outpatient basis:
· elimination of “causal” factors (grinding off sharp edges of teeth, correction of dentures).
Other types of treatment provided at the inpatient level: No.
Other types of treatment provided at the emergency stage: No.
Surgical intervention:
Surgical intervention provided on an outpatient basis: No.
Surgical intervention provided in an inpatient setting:
· Excision of the affected dental area of the jaw
Indications: removal of formation;
Alveoloplasty;
Indications:
· replacement of the defect after resection of the alveolar process with autologous bone.
Further management:
· orthopedic, orthodontic treatment.
Indicators of treatment effectiveness:
· complete removal neoplasms;
· no relapses
· restoration of chewing function
Drugs ( active ingredients), used in the treatment
Hospitalization
Indications for hospitalization.
Indications for emergency hospitalization: No.
Indications for planned hospitalization:
· bleeding of formation;
· dysfunction of eating, speech;
X-ray: destruction of the cortical plate of the alveolar process of the jaw
Prevention
Preventive actions:
· elimination of loads;
· prevention of purulent-inflammatory complications.
Information
Sources and literature
- Minutes of meetings of the Expert Council of the RCHR of the Ministry of Health of the Republic of Kazakhstan, 2015
- List of used literature: 1. Surgical dentistry: Textbook / Ed. T.G. Robustova. – M.: Medicine, 2002. – 59 pp. 2. Gyorgy Szabo Oral and maxillofacial surgery. – Kyiv: Book Plus. – 2005. – 302 p. 4. Karapetyan I.S., Gubaidullina E.Ya., Tsegelnik L.N. Tumors and tumor-like lesions of the oral cavity of the jaws, face and neck M.: Medical Information Agency, 2004. - 232 p. (2nd ed., revised and supplemented) ISBN 5-89481-207-0 5. Kulakov A.A. Surgical dentistry and maxillofacial surgery. National leadership / ed. A.A. Kulakova, T.G. Robustova, A.I. Nerobeeva. - M.: GEOTAR-Media, 2010. - 928 p. 6. Operative Oral and Maxillofacial Surgery John Langdon, Mohan Patel, Peter Brennan, Robert A. Ord. Hodder Arnold. 2011 7. Essentials of Oral and Maxillofacial Surgery Lars Andersson, Karl-Erik Kahnberg, M. Anthony Pogrel. Wiley-Blackwell (an imprint of John Wiley & Sons Ltd) 2014. 8. Oral and Maxillofacial Diseases. Crispian Scully, Stephen Flint, Stephen R. Porter, Khursheed Moos, Jose V. Bagan. Informa Healthcare. 2010 9. Mukovozov I.N. Differential diagnosis of surgical diseases of the maxillofacial region. MEDpress 2001. – 224 p. 10. Differential diagnosis of the giant cell epulis: the malignant melanoma of the oral mucosa: A. Koch, C Boldt, G. Hilge, U. Schüttrumpf. (Mund Kiefer GesichtsChir 1998; 2: 160–162). British Journal of Oral and Maxillofacial Surgery, Vol. 36, Issue 4, p315 Published in issue: August 1998
Information
Protocol developer list:
1. Batyrov Tuleubay Uralbaevich - Chief freelance maxillofacial surgeon of the Ministry of Health of the Republic of Kazakhstan, maxillofacial surgeon highest category, professor, candidate medical sciences, Head of the Department of Dentistry and Maxillofacial Surgery of Astana Medical University JSC;
2. Zhanalina Bakhyt Sekerbekovna - Chief freelance maxillofacial surgeon of the Aktobe region, doctor of the highest category, professor, head of the department surgical dentistry and dentistry childhood. RGKP at the University of West Kazakhstan Medical University named after M. Ospanov;
3. Sagyndyk Hasan Lyukotovich - maxillofacial surgeon of the highest category, candidate of medical sciences, professor of the Department of Dentistry and Maxillofacial Surgery of Astana Medical University JSC;
4. Ikhambaeva Ainur Nygymanovna - clinical pharmacologist, assistant at the department of general and clinical pharmacology of Astana Medical University JSC
Disclosure of no conflict of interest: No.
Reviewer: Ulmeken Rakhimovna Mirzakulova is a maxillofacial surgeon of the highest category, Doctor of Medical Sciences, Professor, Head of the Department of Surgical Dentistry of the RSE at the Kazakh National Medical University named after S. D. Asfendiyarov.
Conditions for reviewing the protocol: Review of the protocol after 3 years and/or when new diagnostic/treatment methods with more high level evidence.
Attached files
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Epulis is a generalized name for tumor-like formations of different origins on the gum. They can occur at a young and mature age, but in women, due to hormonal fluctuations, they are diagnosed 3-4 times more often than in men. In addition to hormonal imbalances, the main reasons for the development of these formations are chronic gum injuries. They may be provoked mechanical damage of various nature: burns, sharp edges of teeth, overhanging fillings, advanced tartar, malocclusions and uncomfortable dentures. In this regard, it is very important to visit the dentist in a timely manner to eliminate provoking factors.
In most cases, epulis does not cause any particular trouble, except for minor discomfort and unaesthetic appearance. However, it all depends on their size and clinical manifestations. Epulis with a diameter of up to 2-3 cm, which do not have a tendency to grow rapidly, are considered benign. With this form there are no complaints of pain, swelling of the gums or loosening of the teeth. Malignant tumors are characterized by the presence of pinpoint foci white, very fast growth, painful sensations, bleeding and destruction of tooth roots in the area where the tumor is located.
Main classification of epulis
There are three main forms: angiomatous, fibrous and giant cell. The first two types affect teeth, and the third can develop in places where they are absent. In addition, when x-ray examination In the angiomatous and fibrous forms, bone changes are not detected, but in the giant cell form they can be pronounced.
Angiomatous usually occurs at a young age and is manifested by the growth of soft tissue of the gums, acquiring a bright red color. Education contains a large number of blood vessels and is localized mainly in the area of the neck of the teeth of the upper or lower jaw. The surface is lumpy and the consistency is hard. Such tumors bleed, grow quickly and tend to recur after removal.
Fibrous epulis It often develops in middle-aged people and is a round formation of dense consistency with bone inclusions. The surface can be either smooth or bumpy, and its main localization is the vestibular side of the premolars and first molars. The color of fibrous epulis is identical to the natural shade of the gums. Unlike the previous type, this formation does not bleed and grows very slowly.
Diagnosis and treatment of epulis
Methods for diagnosing such formations include visual inspection dentist, instrumental examination and radiography to identify the involvement of bone tissue in the process. To make a final diagnosis and determine the form of epulis (benign or malignant), the patient is sent for a general and detailed blood test. In case of unfavorable tests, especially when elevated white blood cells, subsequently a histological examination of the taken material is carried out. In general, the treatment is very successful, since relapses occur in only 10-14% of cases.
The main way is to remove surgically not only the formation itself, but also all damaged tissues. Removal should occur in a timely manner before the epulis affects large areas. Most often, the operation is performed under general anesthesia using a laser that allows you to cauterize and simultaneously disinfect the treated areas. For more fast healing During the rehabilitation period, rinses and additional medications may be prescribed. There is also medical treatment using drugs that stop tumor growth and promote rapid tissue regeneration.
Epulis: classification, pathological anatomy, clinic, diagnosis, differential diagnosis, treatment.
Epulis is a collective concept to a certain extent, uniting tumors and tumor-like formations of various natures that develop on the alveolar process of the jaw.
Clinic
Histologically, three types of epulis are conventionally distinguished:
1) granulomatous.
Granulation tissue noticeably predominates in various stages of its fibrotic transformation, up to the formation of coarse fibrous granulation tissue.
2) Angiomatous.
In addition to the elements characteristic of the first group (the presence of fibrous and granulation tissue), it contains a large number of blood vessels.
3) Giant cell.
They are connective tissue formations with a large number of giant multinucleated cells. However, these cells do not have atypical growth and, having overcome a certain development cycle, turn into complete mature benign (fibrous tissue).
Pathological anatomy
The outer surface of the epulis is covered with epithelium, often a rather thick layer. The tumor consists of elements of connective tissue and blood vessels. The general histological characteristic is the absence of cell atypia and the gradual transition of the tumor into fibrous mature tissue.
Clinic
Fibrous epulis have a dense elastic consistency, round or oval shape. Their surface is smooth or knobby. They are usually located on a wide base, but may also have a pronounced stalk. Mucous membrane, covering the epulis, pale pink. Their growth is very slow and they rarely reach significant sizes.
Angiomatous epulis is localized mainly in the lateral parts of the jaw. The growth of soft tissue of the gums has a bright red color with a cyanotic tint, and a soft-elastic consistency. The surface of the epulis is in most cases finely lumpy, less often smooth. Character-. A significant feature of this type of tumor is easy bleeding (even with the slightest touch), which is often pulsating. Epulis grow relatively quickly and are prone to relapses, especially during pregnancy.
Giant cell epulis has a round, less often ellipsoidal shape, a smooth surface, a soft or elastic-elastic consistency, a dark red color, often a dark red color, often with a pronounced brownish tint. With progressive growth they can reach large sizes. They are painless and bleed moderately when injured. Sometimes imprints of antagonist teeth can be seen on the surface of the epulis.
Diagnostics
The diagnosis is made based on clinical data and the results of histological examination.
Differential diagnosis
It is necessary to differentiate from hypertrophic gingivitis, which is an overgrowth of the gingival papilla. The original tissue of the epulis in some cases is the pericementum of the tooth or the periosteum of the alveoli, in others it is the endosteum and the bone marrow of the spongy substance of the alveolar wall.
Treatment
Treatment consists of excision of the epulis within healthy tissue with destruction of the growth zone. It is often necessary to remove intact teeth in the area where the tumor is located.
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Epulis: classification, pathological anatomy, clinic, diagnosis, differential diagnosis, treatment
Epulis is a collective concept to a certain extent, uniting tumors and tumor-like formations of different nature that develop on the alveolar process of the jaw.
Clinic
Histologically, three types of epulis are conventionally distinguished:
1) granulomatous.
Granulation tissue noticeably predominates in various stages of its fibrotic transformation, up to the formation of coarse fibrous granulation tissue.
2)Angiomatous.
In addition to the elements characteristic of the first group (the presence of fibrous and granulation tissue), it contains a large number of blood vessels.
3) Giant cell.
They are connective tissue formations with a large number of giant multinucleated cells. However, these cells do not have atypical growth and, having overcome a certain development cycle, turn into complete mature benign (fibrous tissue).
Pathological anatomy
The outer surface of the epulis is covered with epithelium, often a rather thick layer. The tumor consists of elements connective tissue and blood vessels. The general histological characteristic is the absence of cell atypia and the gradual transition of the tumor into fibrous mature tissue.
Clinic
Fibrous epulis have a dense elastic consistency, round or oval shape. Their surface is smooth or knobby. They are usually located on a wide base, but may also have a pronounced stalk. The mucous membrane covering the epulis is pale pink. Their growth is very slow and they rarely reach significant sizes.
Angiomatous epulis is localized mainly in the lateral parts of the jaw. The growth of soft tissue of the gums has a bright red color with a cyanotic tint, and a soft-elastic consistency. The surface of the epulis is in most cases finely lumpy, less often smooth. Character-. A significant feature of this type of tumor is easy bleeding (even with the slightest touch), which is often pulsating. Epulis grow relatively quickly and are prone to relapses, especially during pregnancy.
Giant cell epulis has a round, less often ellipsoidal shape, a smooth surface, a soft or elastic-elastic consistency, a dark red color, often a dark red color, often with a pronounced brownish tint. With progressive growth they can reach large sizes. They are painless and bleed moderately when injured. Sometimes imprints of antagonist teeth can be seen on the surface of the epulis.
Diagnostics
The diagnosis is made based on clinical data and the results of histological examination.
Differential diagnosis
It is necessary to differentiate from hypertrophic gingivitis, which is an overgrowth of the gingival papilla. The original tissue of the epulis in some cases is the pericementum of the tooth or the periosteum of the alveoli, in others it is the endosteum and the bone marrow of the spongy substance of the alveolar wall.
Treatment
Treatment consists of excision of the epulis within healthy tissue with destruction of the growth zone. It is often necessary to remove intact teeth in the area where the tumor is located.
