Gingivaland papillary.comp

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Gingivaland papillary.comp

  1. 1. Gingival and Papillary lesions
  2. 2. Gingival Lesions  Epulis (epulides): non-specific term for any solid growth arising from the gingiva or alveolar ridge area  3 “P’s” pyogenic granuloma  peripheral giant cell granuloma  peripheral ossifying fibroma 
  3. 3. Pyogenic Granuloma Benign growth of vascular, granulation tissue  75% occur on gingiva, but may occur anywhere in oral cavity or on skin  Frequently seen in pregnant females (pregnancy tumor)  Presents as painless reddish nodule, may be ulcerated, may grow rapidly and mimic a malignant process 
  4. 4. Pyogenic Granuloma Treat by local excision and removal of local irritants  Lesions in pregnant females may resolve following delivery  10-15% recurrence, especially for gingival lesions 
  5. 5. Peripheral* Giant Cell Granuloma  Benign proliferation of vascular tissue, numerous giant cells, hemosiderin  Alveolar/gingival mass only, adults 40-60 yrs  Painless, bluish-red mass, may be ulcerated or associated with local irritants, may cause “cupping” of underlying bone  Excision, remove irritants; 10-15% recur
  6. 6. Peripheral Ossifying Fibroma  Proliferation of fibrovascular connective tissue with variable calcifications  Thought to arise from PDL cells  Gingival growth, young adults, anterior jaws, females (2:1), often ulcerated  Excision, remove local irritants  10-15% recurrence
  7. 7. Fibroma (irritation fibroma) Most common “growth” of the oral cavity  Excess collagen deposition secondary to chronic trauma (biting)  Buccal/labial mucosa, tongue  Smooth-surfaced, dome-shaped nodule  Dense fibrous connective tissue histopathologically  Conservative excision, remove irritants 
  8. 8. Drug-Related Gingival Overgrowth Phenytoin (Dilantin) was first drug to be associated with gingival enlargement  In the 1980’s, nifedipine and the calcium channel-blocking agents were determined to cause gingival enlargement  Cyclosporine was added to the list shortly after nifedipine 
  9. 9. Drug-Related Gingival Overgrowth Confirm the use of a causative drug  Good oral hygiene, chlorhexidine rinses  Discontinue drugs or replace if possible  Some regression may be seen with discontinuation but not always (gingivectomy)  Synergistic effects may be seen between 2 different drugs 
  10. 10. Gingival Cyst of the Adult  Uncommon cystic lesion, derived from dental lamina rests  Middle-aged adults 40-60 yrs  Mandibular canine/premolar region most common  Bluish-translucent swelling, often centered in attached gingiva Can look like “mucocele”
  11. 11. Gingival Cyst of the Adult  Dx: location excludes salivary gland origin  Treat by local excision  No tendency to recur
  12. 12. Necrotizing ulcerative gingivitis (NUG, trench mouth) Painful infectious disease of rapid onset, primarily affects gingiva (can spread)  Certain bacteria (Fusobacterium nucleatum, Borrelia vincentii) together with predisposing factors:   stress, immunosuppression, poor oral hygiene, poor nutrition, smoking
  13. 13. Necrotizing ulcerative gingivitis (NUG, trench mouth) Adolescents, young adults  Widespread involvement of superficial gingiva, especially interdental papillae  “punched-out” papillae, bleeds easily  Necrotic tissue gives a foul odor  Low-grade fever, lymphadenopathy 
  14. 14. Necrotizing ulcerative gingivitis (NUG, trench mouth) Dx: clinical history and appearance  Thorough gingival debridement with copious irrigation, improve oral hygiene  Chlorhexidine or oral iodine rinses  Systemic broad-spectrum antibiotics   (i.e.  tetracycline, metronidazole, erythromycin) Stop smoking, improve nutrition, evaluate immune function status
  15. 15. Aggressive Periodontitis Rapid alveolar bone loss, often with little clinical signs of inflammation  Any age, often first noted in teenage years  Localized (often 1st molars and incisors) or generalized presentations  Radiographic evidence of rapid bone loss, vertical defects common in localized cases  Teeth may become mobile 
  16. 16. Aggressive Periodontitis      Debridement, local and systemic antibiotic treatment, submit tissue for microscopic examination (biopsy) to rule out other pathologic conditions Extraction of hopeless teeth Majority of patients have a neutrophil dysfunction Prepubertal periodontitis associated with systemic leukocyte dysfunction A. actinomycetemcomitans, P.intermedia, P. gingivalis
  17. 17. Periodontal Abscess Localized pus accumulation at base of periodontal pocket  May be due to chronic periodontitis or acute obstruction of pocket by foreign material (popcorn husk)  Often painful or tender, erythematous, foul taste may be reported, local pressure may release purulence  Tooth usually vital 
  18. 18. Periodontal Abscess Drain purulence, debride area or remove foreign body, analgesics as needed  Treat chronic periodontal disease, if present 
  19. 19. Parulis (sinus tract, gumboil)  Associated with non-vital tooth (decay)  Painless papule on gingiva or palate near apex, reddish with occasional yellow center, pressure may release pus  Extraction or RCT of affected tooth  Cutaneous sinus, rare complication
  20. 20. Retrocuspid papilla Developmental papule(s), bilateral, < 5mm  Mandibular canine area, lingual gingiva  Children, young adults (very common)  Similar to giant cell fibroma microscopically  Dx: clinical appearance, no enlargement  No Tx needed, may regress with time 
  21. 21. Inflammatory Fibrous Hyperplasia  Also known as denture epulis, epulis fissuratum, or denture-induced fibrous hyperplasia  Results from chronic, low-grade irritation from ill-fitting denture flange  May have central fissure  Conservative excision; re-make denture
  22. 22. Inflammatory Papillary Hyperplasia Denture papillomatosis – maxillary complete denture  Central region of hard palatal mucosa  Numerous asymptomatic red papules  Keeping denture out, red → pink, but papules remain  Excision may be needed 
  23. 23. Squamous Papilloma Most common benign epithelial neoplasm seen intraorally, associated with HPV infection  Solitary lesion, typically found on soft palate/uvula, tongue, labial mucosa  Finger-like fronds, usually pedunculated, but may be sessile  Range of color (reddish to white) 
  24. 24. Papilloma - Treatment  Conservative excision, including the base of the lesion  Prognosis is excellent  Recurrences are uncommon; no risk of malignant transformation  Very low transmission rate
  25. 25. Verruca Vulgaris (common wart) Common, benign lesion caused by several strains of HPV  Frequently affects children - hands and facial skin. Less frequent orally than sq. papilloma  Can be transmitted, auto-inoculated  Usually sessile, exophytic, papillary lesion; often multiple on skin but solitary in the mouth (lips, gingiva, tongue, palate) 
  26. 26. Verruca Vulgaris spontaneous regression is common in kids  excision, cryotherapy, keratolytic agents  recurrence not common, but possible 
  27. 27. Condyloma Acuminatum  also known as “venereal warts”  benign epithelial proliferation caused by several strains of HPV, including types 6, 11, 16,18, 53 and 54  oral lesions - multiple, exophytic sessile mass(es), cauliflower surface, pink to white  Lips, soft palate, lingual frenum
  28. 28. Condyloma Acuminatum  excision, cryotherapy, laser excision  recurrence is common - 30% of patients have recurrent lesions after each treatment episode  associated with squamous cell carcinoma of the uterine cervix
  29. 29. Verrucous Carcinoma Uncommon, low-grade variant of oral squamous cell carcinoma  Represents less than 1-10% of oral SCC  Usually develops in elderly male patients  Smokeless tobacco is often mentioned as a contributing factor, particularly in some southern states. These VC’s arise in the area where the tobacco is placed. Can arise from the high risk precancerous condition: PVL 
  30. 30. Verrucous Carcinoma  Clinically presents as an extensive, exophytic, papillary mass or shaggy thick plaque, typically white, crisp borders  Mandibular vestibule, gingiva, hard palate and buccal mucosa are most frequent sites  Tends to grow slowly and laterally, not invasively
  31. 31. Verrucous Carcinoma  Wide surgical excision  Rarely metastasizes  Radiation therapy has been discouraged due to sporadic reports of transformation of verrucous carcinoma to a more aggressive squamous cell carcinoma
  32. 32. Verrucous Carcinoma Prognosis: fair-guarded - approximately 2025% of verrucous carcinomas, upon complete excision, show foci of transformation to routine squamous cell carcinoma

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