Description, Causes and Risk Factors:Overgrowth of tissue in the mucobuccal or labial fold, induced by chronic trauma from ill-fitting dentures.
Epulis fissuratum is an overgrowth of tissue around the flange of a denture that does not fit correctly. The tissue is usually firm with a pinkish appearance, and it has a distinctive fissure where the edge of the flange sits. Denture-wearers can develop this condition if they do not attend regular appointments to check the fit of their dentures and receive periodic adjustments to make sure their oral health is maintained. Women appear more likely to experience epulis fissuratum than men, although the reasons behind this are not clear.
When dentures do not fit properly, they can rub against the cheek and gums, causing irritation over time. Patients may notice problems like pain and soreness, trouble eating, and a feeling of general discomfort. This inflammation can eventually trigger excessive cell growth, and in some cases the new tissue also ulcerates, becoming red, raw, and tender to the touch. The epulis fissuratum may be identified on a routine dental examination or when a patient goes to the dentist to complain of oral pain.
The cause is usually pressure from the flange of a denture which causes chronic irritation and a hyperplastic response in the soft tissues. Fibroepithelial polyps, pedunculated lesions of the palate beneath an upper denture, are associated with this condition. Epulis fissuratum can also appear around dental implants.
This condition occurs in association with denture wearing, and so those affected tend to be middle aged or older adults.
The lesion is usually painless.The usual appearance is of two excess tissue folds in alveolar vestibule/buccal sulcus, with the flange of the denture fitting in between the two folds.It may occur in either the maxillary or mandibular sulci,although the latter is more usual.Anterior locations are more common than posterior.Less commonly there may be a single fold, and the lesion may appear on the lingual surface of the mandibular alveolar ridge.The swelling is firm and fibrous, with a smooth, pink surface.The surface may also show ulceration or erythema.The size of the lesion varies from less than 1 cm to involving the entire length of the sulcus.
The diagnosis is made clinically, and usually this is clear cut if the lesion is associated with the flange of a denture.Tissue biopsy is not usually indicated before removal of the lesion, since the excises surgical specimen is usually sent for histopathologic examination and the diagnosis is confirmed retrospectively. Rarely, incisional biopsy may be indicated to rule out neoplasia, e.g. in the presence of suspicious ulceration. The appearance may also be confused with pyogenic granuloma.The excessive tissue is composed of cellular, inflamed fibrous connective tissue. The appearance of an epulis fissuratum microscopically is an overgrowth of cells from the fibrous connective tissue. The epithelial cells are usually hyperkeratotic and irregular, hyperplastic rete ridges are often seen.
The immediate treatment for epulis fissuratum is oral surgery to remove the excessive tissue. It is advisable to send a sample to a pathologist for evaluation, because while epulis fissuratum is benign, overgrowth can also be a sign of malignancy. A dentist may want to be safe rather than sorry with a check for oral cancer, especially if a patient has a history of risk factors like smoking. Once the patient's mouth has had a chance to heal, a specialist can refit dentures to the mouth and make recommendations for a maintenance schedule to prevent the recurrence of epulis fissuratum and keep the patient comfortable.
In cases where epulis fissuratum is actually a malignant condition masquerading as denture-induced irritation, the patient may need additional surgery, chemotherapy, or radiation. This can prevent recurrence of the unwanted growth and also protects the surrounding teeth and jaw from any remaining cancer cells. Regular checkups are typically recommended to make sure any signs of the cancer's return are caught early so the patient can be treated rapidly.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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