Common Benign Mucosal Swellings of Oral Cavity

Non neoplastic soft tissue
swellings of mouth arising from
oral mucosa.
What we learn here?
SARANG SURESH HOTCHANDANI 2

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.

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

 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

3 types of Epulis are present.
Fibrous Epulis; most common
Vascular Epulis
Giant Cell Granuloma; approx. in 10% of
cases.
Epulis

Common Features to all Epulis;
Common in females.
Mostly on anterior teeth.
More common in MAXILLA
Epulis

Recurrence Rate of Epulis
HIGHEST; Giant Cell
Granuloma
lowest; Fibrous Epulis

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

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)

Excise along with small base of
normal tissue to prevent recurrence.
Curette the underlying bone of nodule
after excision.
Treatment of Fibrous Nodule

 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

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

Dilated blood vessels or
vascular proliferation in
oedematous connective tissue
stroma
Vascular Epulis (Histology)

 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

 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

 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

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

 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

 They are benign epithelial tumour growing exophytically
(outward projecting).
 Clinical Features;
 Spiky, exophytic or round cauliflower like.
 Aetiology;
 Human Papilloma Virus
Papilloma

 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

 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

 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.

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.

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.

 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

AETIOLOGY
Ill fitting denture
Poor oral hygiene
Sleeping with dentures

Histology
Lesion shows papillary projections having
core of hyperplastic, chronically inflamed
granulation tissue covered by hyperplastic
stratified squamous tissue.

Management
Clean denture
Avoid wearing denture overnight
Antifungal drugs for candidiasis

Final Year BDS Student
Bibi Aseefa Dental College
Shaheed Mohtarma Benazir Bhutto
Medical University
Larkana, Sindh
PAKISTAN
SARANG SURESH
HOTCHANDANI

Common Benign Mucosal Swellings of Oral Cavity

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