2. Non neoplastic soft tissue
swellings of mouth arising from
oral mucosa.
What we learn here?
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3. Fibrous Nodule
Most common soft tissue swellings of mouth.
Appear as hyperplastic swellings at those sites
where minor chronic injury OR low grade infection occurs.
NODULE; Well circumscribed solid, elevated lesion more
than 5mm in diameter.
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4. Epulis/Epulides; it is fibrous nodule on gingiva.
Denture induced granuloma; these are fibrous
nodules formed in denture wearers.
Fibrous Polyp; it is fibrous nodule growing on
buccal mucosa.
Fibrous Nodule
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5. Usually caused by irritation of gingival margin by;
Sharp edges of carious cavity
Calculus
Mostly occur on anterior teeth in interdental area.
Lesion is usually firm, pink in color & non –
ulcerated.
Epulis
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6. 3 types of Epulis are present.
Fibrous Epulis; most common
Vascular Epulis
Giant Cell Granuloma; approx. in 10% of
cases.
Epulis
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7. Common Features to all Epulis;
Common in females.
Mostly on anterior teeth.
More common in MAXILLA
Epulis
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9. Present as pedunculated or sessile mass
Firm in consistency and has similar color to
normal gingiva.
May or may not be ulcerated.
If ulceration is present, lesion is covered by
yellowish fibrinoid exudate.
Mostly b/w 11 – 40 years of age.
Fibrous Epulis
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10. Cellular fibrous granulation tissue.
Mature collagen fibre bundles
Plasma cell infiltrate
Deposits of calcification or trabeculae of
metaplastic bone are found within
granulation tissue.
Fibrous Epulis
(Histological Features)
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11. Excise along with small base of
normal tissue to prevent recurrence.
Curette the underlying bone of nodule
after excision.
Treatment of Fibrous Nodule
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12. Appear as soft, deep red or purple swelling.
Usually ulcerated & haemorrhaging with spontaneous or
minor trauma.
Classified into two types Clinically;
Pyogenic granuloma
Pregnancy Epulis
Vascular Epulis
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13. It is pyogenic granuloma in pregnant patients
Usually at the end of 1st trimester.
After delivery may regress spontaneously or
converted to fibrous Epulis.
Excision of this lesion should be avoided
before conversion to fibrous because of risk of
excessive haemorrhage.
Pregnancy Epulis
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14. Dilated blood vessels or
vascular proliferation in
oedematous connective tissue
stroma
Vascular Epulis (Histology)
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15. Polyp is a swelling with narrow base.
Usually appear on buccal mucosa along occlusal line
Usually caused by chronic cheek bite, ulceration uncommon.
Lesion appear as firm, painless, polyp covered by mucosa of
normal appearance.
One established does not grow further.
Fibrous Polyp
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16. Sometimes surface is white due to frictional
keratosis.
Histological features;
Core of dense, avascular and acellular fibrous tissue with
interlacing bundles of collagen fibres covered by hyperplastic
stratified squamous epithelium which is sometimes hyperketosed.
Fibrous Polyp
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17. It is produced by irritation of alveolar or palatal mucosa by
roughened area on denture.
Usually forms at margins of denture.
Most frequently at lower denture.
These all types of fibrous nodules are pale and firm, but they
can be abraded and ulcerated and inflammation can occur later.
Denture Granuloma
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18. This is also fibrous hyperplasia but does
not produce swelling.
Usually are flat and develop b/w denture
& mucosa (not on denture margins unlike
denture granuloma)
Leaf Fibroma
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19. It is variant of fibrous Epulis and can be found only on
histological examination.
It is characterized by containing large, mono nucleate, stellate &
darkly stained cells b/w short coarse fibrous tissue bundles.
Clinically they are pedunculated & usually arise from gingiva or
tip of tongue.
Giant Cell Fibroma
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20. They are benign epithelial tumour growing exophytically
(outward projecting).
Clinical Features;
Spiky, exophytic or round cauliflower like.
Aetiology;
Human Papilloma Virus
Papilloma
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21. Oral papilloma are non premalignant.
Squamous Cell Papilloma
Mainly affects Adults.
Appear as cauliflower like or finger like
Mostly white due to keratinization.
Histology
The papilla consists of vascular connective tissue core surrounded by
squamous epithelium.
Papilloma
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22. Aka Giant Cell Epulis
Males ~ 20 years & Females ~ 50 years
Mostly occur on anterior teeth.
Mostly occur in MANDIBLE
Female to Male Ratio ~ 2:1
Peripheral Giant Cell Granuloma
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23. Clinical Features
Present as pedunculated, sessile swelling of varying size.
Dark red, maroon or purplish in colour & commonly
ulcerated.
Usually occur on marginal gingiva.
Sometimes associated with recently lost deciduous teeth.
Usually occur on interdental areas and may have
hourglass shape due to joining of buccal & lingual
swelling.
Peripheral Giant Cell Granuloma
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24. Radiographic Features
Shows superficial erosion of crest of
interdental bone/alveolar margin.
Radiograph is required to reach diagnosis
because sometimes central giant cell
granuloma may perforate the cortex of
alveolar bone & appear as peripheral giant cell
granuloma.
Peripheral Giant Cell Granuloma
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25. Histological Features
Focal collections of multinucleated osteoclast like
giant cells separated by fibrous septa in vascular or
cellular stoma.
The lesion is covered by stratified squamous
epithelium.
A narrow fibrous tissue separate the core lesion
from stratified squamous epithelium.
Peripheral Giant Cell Granuloma
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26. Present as numerous, small, tightly packed papillary
projection over denture bearing area of palate.
Gives hard palate Pebbled Appearance.
Mucosa is often Red & oedematous, sometimes
associated with candidiasis.
Papillary Hyperplasia of Palate
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30. Final Year BDS Student
Bibi Aseefa Dental College
Shaheed Mohtarma Benazir Bhutto
Medical University
Larkana, Sindh
PAKISTAN
SARANG SURESH
HOTCHANDANI
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