Epulis

Epulis (plural epulides) is any tumor like enlargement (i.e. lump) situated on the gingival or alveolar mucosa.^[1][2] The word literally means "on the gingiva",^[3] and describes only the location of the mass and has no further implications on the nature of the lesion.^[4] There are three types: fibromatous, ossifying and acanthomatous. The related term parulis (commonly called a gumboil) refers to a mass of inflamed granulation tissue at the opening of a draining sinus on the alveolus over (or near to) the root of an infected tooth.^[2] Another closely related term is gingival enlargement, which tends to be used where the enlargement is more generalized over the whole gingiva rather than a localized mass.

Epulis fissuratum

This is a fibrous hyperplasia of excess connective tissue folds that takes place in reaction to chronic trauma from an ill fitting denture. It usually occurs in the mandibular labial sulcus. Sometimes the term epulis is used synonymously with epulis fissuratum,^[2] but this is technically incorrect as several other lesions could be described as epulides.

Pyogenic granuloma

This type of epulis is neither pyogenic ("pus producing") nor a true granuloma, but it is a vascular lesion. About 75% of all pyogenic granulomas occur on the gingiva,^[2] although they may also occur elsewhere in the mouth or other parts of the body (where the term epulis is inappropriate). This common oral lesion is thought to be a reaction to irritation of the tissues and poor oral hygiene. It is more common in younger people and in females, and appears as a red-purple swelling and bleeds easily.

Pregnancy epulis

Also termed a "pregnancy tumor" or "granuloma gravidarum",^[2] this lesion is identical to a pyogenic granuloma in all respects apart from the fact that it occurs exclusively in pregnant females.^[3] There is usually pregnancy gingivitis also.^[3] Pregnancy epulis commonly occurs during the third trimester of pregnancy.^[5]

Fibrous epulis

This epulis most commonly occurs on the gingiva near the front of the mouth between two teeth.^[3] It may be sessile or pedunculated and is composed of fibrosed granulation tissue. Fibrous epulides are firm and rubbery, and pale pink in color. Over time, bone may form within the lesion at which point the term peripheral ossifying fibroma may be used (in some parts of the world).

Ossifying fibroid epulis

This is a long-standing fibrous epulis in which bone has begun to form. Not to be confused with ossifying fibroma.

Giant cell epulis

This epulis contains giant cells. It is also termed peripheral giant cell granuloma

Epulis granulomatosa

An epulis granulomatosa is a granuloma which grows from an extraction socket (the hole left after a tooth has been removed), and as such can be considered to be a complication of healing after oral surgery.^[6]

Congenital epulis

This rare epulis (also called granular cell tumor or congenital gingival granular cell tumor) is not acquired,^[7] which is in contrast to most other epulides which tend to be reactive lesions to tissue irritation. It is also called Neumann's tumor. It has an unusual resemblance to granular cell myoblastoma. It is more common in the maxilla than the mandible. It is usually a pedunculated lesion in the incisor region.

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