Oral Pathology Presentation containing common mucosal swellings in oral cavity, e.g. epulis, papilloma, granuloma, etc.

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2. Non neoplastic soft tissue
swellings of mouth arising from
oral mucosa.
What we learn here?
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3. 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.
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4. 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
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5.  Usually caused by irritation of gingival margin by;
 Sharp edges of carious cavity
 Calculus
 Mostly occur on anterior teeth in interdental area.
 Lesion is usually firm, pink in color & non –
ulcerated.
Epulis
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6. 3 types of Epulis are present.
Fibrous Epulis; most common
Vascular Epulis
Giant Cell Granuloma; approx. in 10% of
cases.
Epulis
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7. Common Features to all Epulis;
Common in females.
Mostly on anterior teeth.
More common in MAXILLA
Epulis
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8. Recurrence Rate of Epulis
HIGHEST; Giant Cell
Granuloma
lowest; Fibrous Epulis
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9. 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
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10. 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)
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11. Excise along with small base of
normal tissue to prevent recurrence.
Curette the underlying bone of nodule
after excision.
Treatment of Fibrous Nodule
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12.  Appear as soft, deep red or purple swelling.
 Usually ulcerated & haemorrhaging with spontaneous or
minor trauma.
 Classified into two types Clinically;
 Pyogenic granuloma
 Pregnancy Epulis
Vascular Epulis
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13. 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
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14. Dilated blood vessels or
vascular proliferation in
oedematous connective tissue
stroma
Vascular Epulis (Histology)
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15.  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
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16.  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
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17.  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
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18. 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
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19.  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
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20.  They are benign epithelial tumour growing exophytically
(outward projecting).
 Clinical Features;
 Spiky, exophytic or round cauliflower like.
 Aetiology;
 Human Papilloma Virus
Papilloma
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21.  Oral papilloma are non premalignant.
 Squamous Cell Papilloma
 Mainly affects Adults.
 Appear as cauliflower like or finger like
 Mostly white due to keratinization.
 Histology
 The papilla consists of vascular connective tissue core surrounded by
squamous epithelium.
Papilloma
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22.  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
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23.  Clinical Features
 Present 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.
Peripheral Giant Cell Granuloma
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24. Radiographic Features
Shows 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.
Peripheral Giant Cell Granuloma
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25. Histological Features
Focal 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.
Peripheral Giant Cell Granuloma
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26.  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
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27. AETIOLOGY
Ill fitting denture
Poor oral hygiene
Sleeping with dentures
Papillary Hyperplasia of Palate
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28. Histology
Lesion shows papillary projections having
core of hyperplastic, chronically inflamed
granulation tissue covered by hyperplastic
stratified squamous tissue.
Papillary Hyperplasia of Palate
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29. Management
Clean denture
Avoid wearing denture overnight
Antifungal drugs for candidiasis
Papillary Hyperplasia of Palate
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30. Final Year BDS Student
Bibi Aseefa Dental College
Shaheed Mohtarma Benazir Bhutto
Medical University
Larkana, Sindh
PAKISTAN
SARANG SURESH
HOTCHANDANI
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