Common Benign Mucosal Swellings of Oral Cavity

SARANG SURESH HOTCHANDANI

COMMON BENIGN MUCOSAL SWELLINGS

SARANG SURESH HOTCHANDANI 2

Non neoplastic soft tissue swellings of mouth

arising from oral mucosa.

What we learn here?


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.


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


Usually caused by irritation of gingival margin by;Sharp edges of carious cavityCalculus

Mostly occur on anterior teeth in interdental area.

Lesion is usually firm, pink in color & non – ulcerated.

Epulis


3 types of Epulis are present. Fibrous Epulis; most common Vascular EpulisGiant Cell Granuloma; approx. in 10% of cases.

Epulis


Common Features to all Epulis;Common in females.Mostly on anterior teeth.More common in MAXILLA

Epulis


Recurrence Rate of Epulis HIGHEST; Giant Cell Granuloma

lowest; Fibrous Epulis


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


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)


Excise along with small base of normal tissue to prevent recurrence.

Curette the underlying bone of nodule after excision.

Treatment of Fibrous Nodule


Appear as soft, deep red or purple swelling.

Usually ulcerated & haemorrhaging with spontaneous or minor trauma.

Classified into two types Clinically;Pyogenic granulomaPregnancy Epulis

Vascular Epulis


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


Dilated blood vessels or vascular proliferation in oedematous connective

tissue stroma

Vascular Epulis (Histology)


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


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


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


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


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


They are benign epithelial tumour growing exophytically (outward projecting).

Clinical Features;Spiky, exophytic or round cauliflower like.

Aetiology; Human Papilloma Virus

Papilloma


Oral papilloma are non premalignant.

Squamous Cell PapillomaMainly affects Adults.Appear as cauliflower like or finger like Mostly white due to keratinization.

HistologyThe papilla consists of vascular connective tissue core

surrounded by squamous epithelium.

Papilloma


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


Clinical FeaturesPresent 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.



Radiographic FeaturesShows 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.



Histological FeaturesFocal 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.



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


AETIOLOGYIll fitting denturePoor oral hygiene Sleeping with dentures



HistologyLesion shows papillary projections having core of hyperplastic, chronically inflamed granulation tissue covered by hyperplastic stratified squamous tissue.



ManagementClean dentureAvoid wearing denture overnightAntifungal drugs for candidiasis



Final Year BDS StudentBibi Aseefa Dental CollegeShaheed Mohtarma Benazir Bhutto Medical UniversityLarkana, Sindh PAKISTAN

SARANG SURESH HOTCHANDANI

Common Benign Mucosal Swellings of Oral Cavity

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