Epulis is the name given to a benign gum tumor. It belongs to the dental granulomas.
What is an epulis?
An epulis refers to a nodular, isolated growth that grows on the gums and is benign in nature. Epulides are tissue growths that dentists also call granulomas. The name epulis comes from the Greek and means “on the gums“. Epulides have the shape of mushrooms or hemispheres and in most cases sit on the edge of the gums. In dentistry, epulis is also called focal fibrous hyperplasia. The origin of the tissue growths is usually mesenchymal. Only rarely do they originate from the epithelium. Subdivided, epulis is of several types:
- The epulis granulomatosa
- The epulis fibromatosa
- The epulis gigantocellularis
- The Epulis sarcomatodes
Epulis granulomatosa is a soft nodular change that is bright red to red and bleeds easily. Its shape is reminiscent of a hemisphere. Epulis granulomatosa grows on the edge of the gum. If it is located at the neck of the tooth, recurrences are not uncommon. Epulis fibromatosa occurs when the mucous membrane of the gums changes and becomes rough, broad-based and pale. A uniform meshwork is formed by the collagen-rich fibrous tracts. Epulis fibromatosa is considered a mature epulis-granulomatosa form. Epulis gigantocellularis is a peripheral giant cell granuloma. It is noticeable as a dark red nodular change on the gums, which is blurred. It usually develops in the region of the posterior teeth or on edentulous ridges. The female sex is particularly affected by epulis gigantocellularis. Epulis sarcomatodes is a rarely occurring form of epulis. Its name can be traced to the proliferating connective tissue, which resembles a sarcoma.
Causes
Epulis represents granulation tissue that has different cellular structures. The tumor formation is usually caused by chronic dental inflammation that occurs in the region of the tooth root apex. Inflammation of the jaw can also result in epulis formation. The same applies to mechanical stimuli. A special form of epulis is pregnancy epulis. It is also called granuloma gravidarum. It is caused by hormonal changes that occur during pregnancy. These hormonal changes have a negative effect on the oral cavity. Whether pregnancy epulis is ultimately triggered by hormones such as estrogen or progesterone, a weakened immune system or a dysbalance of the oral flora has not yet been clarified. In Germany alone, two to ten percent of all pregnant women are affected by epulis. It mostly appears between the 2nd and 3rd month of pregnancy and can be associated with pregnancy gingivitis.
Symptoms, complaints and signs
In most cases, the development of epulis is not noticed until the gums bleed or hurt when pressure is applied. Bleeding occurs very quickly in the setting of epulis. The growths bulge forward on the gums and may take on a pink or reddish-bluish color. Another characteristic of epulis is the formation of nodules. The pain is more or less severe.
Diagnosis
If epulis is suspected, a visit to the dentist is recommended. After describing the symptoms, the dentist performs a thorough examination of the oral cavity. The fungal granulomas can usually be easily seen with the naked eye, so that an X-ray is usually unnecessary. In addition, the dentist looks for possible caries lesions or defective fillings or crown margins. In order to rule out a malignant growth, some tissue is removed, which is examined for its cell type in a laboratory. In most cases, epulis takes a positive course after dental treatment, so that the patient no longer experiences any discomfort. However, if remnants of the granuloma remain, there is a risk of recurrence, so renewed therapy is required.
Complications
Elevated blood lipids can cause a number of complications because they lead to damage to the blood vessels.These are due to deposits of cholesterol and other substances on the vessel walls, causing the diameter to become narrower over time. In addition, the vessel walls become increasingly rigid and porous. Arteriosclerotically altered vessels develop. Specifically, complications include:
The heart muscle is no longer supplied with blood properly because the coronary vessels calcify. Remarkable this heart attack by a left-sided, drilling pain in the chest area, which radiates into the left arm.
- Heart attack
This is caused by a narrowing and calcification of one or more branches of the coronary arteries. If complete occlusion occurs, the associated area of the heart muscle dies due to the lack of blood supply. The resulting heart attack is life-threatening,
- Stroke
If the brain is no longer supplied with blood properly or not at all due to a narrowing of the blood vessels, the worst case scenario is a stroke. On the other hand, blood vessels that have become porous can lead to bleeding into the brain. Depending on the affected areas, paralysis, speech disorders or death may result.
- Circulatory disorders in the legs
Due to deposits, the leg arteries can be so narrowed that the blood supply is disturbed. There is an acute lack of oxygen. This leads initially to muscle pain and subsequently to occlusive disease. Epulis can cause various complications if left untreated. First, the benign gum tumor causes bleeding and pain in the oral cavity. The affected gums are sensitive to pressure and usually swell immediately. This can cause problems with chewing and speaking. In the long term, malpositions can develop from an untreated tumor. In the further course, inflammatory nodules eventually form in the oral cavity. If these burst open, severe infections in the mouth and throat can occur, but also an enlargement of the original tumor. Rarely, an epulis may develop into a malignant tumor or epulis gigantocellularis. The latter spreads to the adjacent bone tissue in the course of the disease and almost always leads to further complications. In severe cases, it is necessary to remove the surrounding teeth. In addition, cysts can form in the area of the jawbone and damage it. When treating an epulis, parts of the tissue and bone must be removed. Postoperative bleeding may occur and excessive scarring may occur. Rarely, the epulis will grow back and require re-treatment.
When should you see a doctor?
If the gums bleed or hurt when pressure is applied, it is often an epulis. A visit to the doctor is necessary if the symptoms have not subsided after a few days. Anyone who notices ulcers is best to contact the dentist immediately. Severe bleeding, inflammation or injuries in the oral cavity should also be clarified immediately before secondary complaints develop. If complications already occur – such as difficulty swallowing or problems with food intake – a doctor’s appointment should be arranged quickly. People with chronic dental inflammation or jaw infections are particularly susceptible to epulis. So are people who regularly grind their teeth or have recently injured the inside of their mouth. Anyone who belongs to these risk groups is best advised to seek medical advice. If the above-mentioned complaints occur during pregnancy, it is possible that pregnancy epulis is present. Here, too, the rule is to consult a doctor promptly and have the complaints examined. Depending on the severity, the dentist or an orthodontist may be called in. In case of severe discomfort, the emergency medical service should be contacted.
Treatment and therapy
If an epulis causes discomfort, its treatment is performed by surgical intervention. In this procedure, the lump is surgically removed. The patient receives a local anesthetic during the minor procedure. To prevent epulis from developing again, a certain part of the bone and periosteum should also be operated out. The same applies to a specific region of the periodontal fibrous apparatus. Sometimes, treatment of the tooth root or gums is also necessary. In this way, the triggering inflammation can be pushed back.If this treatment is not successful, which is rarely the case, the tooth in question must be extracted. Another therapeutic step is the removal of tartar and calculus from adjacent teeth. If a recurrence occurs, the adjacent tooth must also be treated. If the patient suffers from epulis gigantocellularis, additional treatment of the adjacent bone with a drill is necessary. Thus, the recurrence rate of peripheral giant cell granuloma proves to be very high. Depending on how extensive the wound turns out to be during the procedure, it either remains open or is sutured by the dentist. If it is a pregnancy epulis, the end of the pregnancy is usually waited for. Usually, the lump will then regress on its own.
Outlook and prognosis
Epulis often regresses spontaneously. Medical treatment is usually sufficient to resolve the growth and minimize any accompanying symptoms. Epulis regresses within a few days to weeks, usually with no pain or other symptoms. Large-sized growths can cause bleeding as well as problems with speech. In addition, painful swelling and discomfort may occur. In individual cases, the epulis forms further growths, which may appear on the entire face. Very rarely, recurrences occur. In principle, however, the disease offers a good prognosis. Provided it is recognized and treated early, it should resolve quickly without complications or long-term consequences. Well-being is not necessarily affected by the entity. Life expectancy is not reduced if the course is positive. The prognosis is worse if the disease is malignant. Then severe complications such as tumor formation may occur. There is also an increased risk of recurrence, which can occur months or years after treatment. Accordingly, the patient is dependent on regular progress controls so that medical measures can be taken promptly in any case of a health problem.
Prevention
It is not possible to directly prevent the development of epulis. However, regular care of teeth and oral cavity is considered important to counteract inflammation.
Aftercare
In most cases of epulis, only very limited measures or options for aftercare are available to the affected person. In this case, the affected person is primarily dependent on a quick and on a comprehensive examination and diagnosis, so that no further complications or complaints occur. The sooner a doctor is consulted in the case of epulis, the better the further course of this disease usually is. For this reason, the early detection of this disease is in the foreground, so that a doctor should be consulted at the first signs and symptoms. The treatment itself is usually carried out with the help of creams or medications, although in some cases oral surgery is necessary to completely limit the symptoms of epulis. However, the affected person should generally pay attention to a high standard of hygiene. This includes regular brushing of the teeth and further also the use of a mouth rinse. When taking medication, care should be taken to ensure that it is taken regularly and also that the dosage is correct. As a rule, the disease epulis does not reduce the life expectancy of the affected person and there is also a complete cure without complications.
What you can do yourself
An epulis is a benign gum growth that is usually due to chronic inflammation of the tooth or gums. Such a growth is not dangerous, but a sufferer should still see a dentist promptly to have the disorder treated causally. The underlying disease can cause significant complications, including tooth loss. The patient cannot contribute much to the treatment of the tumor itself. However, he can prevent the most common underlying diseases by taking a number of measures. Above all, good oral hygiene is important. Teeth should be cleaned at least in the morning and evening, but preferably after every meal. Toothbrushes are the perfect breeding ground for bacteria because they are constantly moist, tiny bits of food get caught in the bristles, and they are usually kept in a well-heated bathroom.Toothbrushes with a high microbial load can exacerbate an already existing inflammation in the oral cavity. The instruments should therefore be cleaned well after each use and finally rinsed with cold water. In addition, toothbrushes must be replaced regularly. Oral hygiene can be significantly increased by using mouthwash and dental floss. In addition, regular checkups with the dentist are necessary so that diseases of the teeth and gums can be detected and treated before serious damage to the tooth or other complications occur.