This document presents a case study of a 35-year-old female patient who presented with a large painless swelling in her upper jaw that had developed over the past 4 months. The patient had a history of surgical excision of epulis lesions twice previously. Clinical examination revealed a swelling on the palatal mucosa near her upper left central incisor. A provisional diagnosis of recurrent fibrous epulis was made. The lesion was surgically excised and medications were prescribed to aid healing. Follow-up appointments showed the area was healing properly.

1. Presented by-
Dr. Ha-Meem Fattaha
IS Batch – 26
Sapporo Dental College & Hospital
PRESENTATION ON EPULIS
Department of Oral Pathology & Periodontology

2. What is epulis?:
Epulis a generic term used clinically to describe tumor
and tumor like mass of the gingiva. The term refers
only to the site of the lesion, but it does not describe
it. Most lesions referred to as ‘epulis’ are inflammatory
rather than neoplastic.

3.  Particular’s of the patient:
 Name: Rina
 Age: 35 years
 Sex: Female
 Reg. No: 76422/15
 Occupation: Maid servant
 Marital status: Unmarried
 Address: Sector- 10,
Uttara, Dhaka.
 Date: 12.02.15

4.  Chief complain:
Large painless swelling present in the anterior segment
of upper jaw for last 4 months.
 History of present illness:
According to the patients statement she was alright 4
months back. Then she developed a painless swelling
in the anterior segment of upper jaw. The swelling
increased in size gradually. Bleeding occurs from the
surrounding gum during brushing.

5.  Medical history:
 Anemia: Present
 Jaundice: Absent
 Blood pressure: 110/ 70 mm of Hg
 Diabetes mellitus: Absent
 Bleeding disorder: Absent
 Rheumatic fever: Absent
 Others: Absent
 Past dental history:
Surgical excision of epulis 2 times.

6.  Maintenance of oral hygiene:
She maintains her oral hygiene by brushing her teeth
once before breakfast with brush and paste.
 Personal & social history:
She belongs to a low socio-economic family. Her
parents passed away and they had no history of
significant disease. She is not habituated with betel
quid or tobacco.

7.  Examination:
General Examination:
Anemia present.
Systemic Examination:
Nothing abnormal detected.
Local Examination:
EXTRA ORAL:
 Regional Lymph node: Not palpable
 Temporo-mandibular joint: Normal
 Salivary gland: Not palpable
 Lip: Incompetent
 Others: Nothing abnormal detected.

8. INTRA ORAL:
 Swelling: Swelling present in palatal mucosa in relation
to the mesial surface of upper left central incisor.
 Oral mucosa: Pale pink in color

9.  Gingiva: Gingival swelling present in some areas and
gingival recession present.

10.  Before scaling:

11.  After scaling:

12.  Investigations:
 Blood for- CBC, HbsAg, AntiHCV
 Periapical radiograph ( Previously done)
Fig: Periapical radiography exhibiting no osseous or dental involvement

13.  Provisional diagnosis:
Recurrent fibrous epulis.
 Clinical diagnosis:
Recurrent fibrous epulis on upper anterior region in
relation to upper left central incisor.
 Treatment:
Surgical excision and deep curettage of epulis with
surrounding normal tissue.

14.  Operative procedure:
(23.02.15)
 Under all aseptic precaution local
anaesthesia was given.
 After confirmation of the anaesthesia
the lesion was excised with electric
knife without removing the tooth.

15.  The underlying bone was curetted and cauterization was
done.
 After removal thorough irrig-
-ation was done with 10% povidi-
-ne iodine and perio pack was
given.
 Advised for biopsy.

16.  Medications:
 Cap.Cefixime 200 mg(cap.Cef-3 200 mg)
1+0+1x12 hourly for 7 days.
 Tab.ketorolac 10 mg(Tab.Torax 10 mg)
1+0+1x12 hourly if pain after meal.
 Cap.Omeprazole20 mg(Cap.Seclo 20 mg)
1+0+1xHalf an hour before meal.
 Tab. Vitamin C 1000mg(Tab.Cevit forte)
1+0+1xmixing with half glass of water for 20 days.

17.  Medications:
 Ferrous Sulphate (Cap.Zif)
1+0+1 for 30 days.
 Cap.Tranexamic Acid 500 mg(Cap.Frabex 500 mg)
1+0+1 for 3 days.
 Mouth wash- Viodin 1%
Diluted with ewual amount of warm water and rinse
3-4 times Per day for 15 days.

18.  1st Follow up- After 7 days
(02.03.15):

19.  2nd Follow up- After 21 days
(16.03.15):

20.  References:
 CAWSON’s essentials of oral pathology and oral
medicine
8th edition.
 CARRANZA’S clinical periodontology
10th edition.