What are the types
Epulises are distinguished by the structure of the tissue, and the behavior of the formation depends on this. The fibrous version is dense, pale, grows slowly and hardly bleeds. Angiomatous is rich in blood vessels, so it is bright red or bluish, bleeds easily even with a light touch, and is more common in children and pregnant women. The giant cell variant is soft, lumpy, purplish, tends to erode the underlying bone, and more often returns after removal. The species can only be determined by appearance only tentatively; the exact answer is provided by examination of the removed tissue.
- Fibrous: dense, pale, slow growing
- Angiomatous: red-bluish, bleeds easily
- Giant cell: soft, lumpy, may involve bone
- Epulis of pregnancy: appears in the second or third trimester
- The exact type is determined by histology
Causes and risk factors
The main reason is constant mechanical or inflammatory irritation of the gingival margin. The gums respond to it with excessive growth of connective tissue. Therefore, epulis almost always occurs next to a tooth that has a problem: a sharp edge, a chip, an overhanging filling, deep tartar. Hormonal changes during pregnancy enhance the reaction of gum vessels to plaque, which is why the formation appears faster and grows more actively. In itself, it is not contagious and cannot be transmitted to other people.
- Tartar and chronic gum inflammation
- Overhanging edges of fillings and crowns
- Sharp edges of decayed teeth
- Injury to the gums due to dentures or braces
- Hormonal changes during pregnancy
- Insufficient oral hygiene
Symptoms
Typically, a person notices a painless nodule on the gum that interferes with the tongue or cheek. Over time, it enlarges, begins to be injured when chewing and bleeds when brushing your teeth. Large formations displace adjacent teeth and create a gap between them. Pain occurs if the surface becomes ulcerated or becomes infected. There is no temperature or general complaints with epulis - their appearance indicates another process and requires urgent examination.
- Nodule on the gum near the tooth
- Bleeding when brushing and chewing
- A feeling of blockage in the mouth
- Displacement or mobility of adjacent teeth
- Ulceration of the surface due to injury
- There is usually no pain
Diagnostics
The dentist examines the formation, assesses its density, base and condition of neighboring teeth, checks for the presence of plaque and stone. A targeted X-ray is required: it shows whether there is bone destruction under the formation and in what condition the roots of the teeth are. The final diagnosis is made only after a histological examination of the removed tissue, because similar formations are produced by peripheral granuloma, cyst, fistula during periodontitis and, in rare cases, malignant tumors of the mucous membrane.
- Inspection and probing of formation
- Targeted dental x-ray
- Assessment of dental and periodontal condition
- Histological examination of removed tissue
- Additional tomography for bone lesions
Treatment and prevention of relapse
Surgical treatment: the formation is excised within healthy tissue along with the attachment zone, otherwise it will grow back. At the same time, the cause is eliminated - tartar is removed, overhanging edges of fillings are polished, a damaged tooth is treated or removed, and the prosthesis is adjusted. With the giant cell variant, treatment of the underlying bone is sometimes required. In pregnant women, a small mass is often observed and removed after childbirth if it does not interfere or bleed; The decision is made by the doctor together with the obstetrician-gynecologist. After surgery, careful hygiene and follow-up examination are important.
- Excision of formation within healthy tissue
- Removing tartar and plaque
- Correction of fillings, crowns and dentures
- Treatment or removal of the causative tooth
- Bone treatment for giant cell variant
- Follow-up examination and careful hygiene after surgery