Epulis is a general descriptive term used in dentistry for any localized, tumor-like enlargement or lump that appears on the gum tissue or the alveolar mucosa. The word simply means “growth on the gums,” describing only the location, not the composition of the mass. This common localized overgrowth is classified as a reactive hyperplastic lesion, meaning the tissue is responding to an irritant by overgrowing.
Defining Epulis: Appearance and Location
The physical appearance of an epulis varies widely, but it typically presents as a painless mass on the gingiva. Color ranges from pale pink to deeper red or purple, depending on the blood vessel content. Lesions can be sessile (having a broad base attached to the gum) or pedunculated (growing on a distinct stalk).
Epulides vary in size, from a few millimeters to several centimeters, and may have a smooth or lobulated (bumpy) surface. They are most commonly found on the gingiva, often appearing in the interdental space between teeth. They occur more frequently on the upper jaw (maxilla) than the lower jaw (mandible), particularly near the front teeth.
Understanding the Different Types
Although the term epulis is descriptive, the growth falls into distinct, overwhelmingly benign categories based on tissue composition. The most common subtype is the Fibrous Epulis, characterized by a firm, rubbery consistency and a pale pink color, as it is composed mainly of dense fibrous connective tissue. This type often represents the final stage of other epulides that have matured into scar tissue.
The Pyogenic Granuloma is softer and deep red or purplish due to its highly vascular nature, causing it to bleed easily. When this growth develops during pregnancy due to hormonal changes, it is often called a “Pregnancy Epulis.” The Peripheral Giant Cell Granuloma (PGCG) is a less frequent type that appears darker and more vascular than the fibrous type. It is distinct because it contains multinucleated giant cells within its structure.
A rare form is the Congenital Epulis, which is present on the alveolar ridge of a newborn infant, typically appearing as a smooth, pink nodule. Because the various types can look similar clinically, a definitive diagnosis requires a detailed examination of the tissue under a microscope.
Primary Causes and Risk Factors
The main reason an epulis forms is chronic, low-grade irritation or trauma to the gum tissue. Local factors, such as the accumulation of dental plaque and calculus (tartar), provide a constant source of inflammation that triggers tissue overgrowth. Physical trauma from a broken filling, a sharp tooth edge, or a poorly fitting denture also acts as a continuous irritant.
These irritants cause the cells in the gingiva or periodontal ligament to react by rapidly multiplying, resulting in the visible mass. Hormonal shifts are another significant factor, particularly the elevated levels of estrogen and progesterone during pregnancy. These hormones exaggerate the inflammatory response, leading to the increased incidence of pyogenic granuloma in pregnant individuals.
Diagnosis and Treatment Options
A definitive diagnosis for any oral lump requires a histopathological examination of the tissue, obtained through a biopsy. A biopsy is necessary to confirm the exact nature of the lesion and rule out any potential malignant conditions that might mimic an epulis. This ensures the treatment plan is appropriate for the confirmed tissue type.
The standard treatment is simple surgical excision, which involves removing the growth entirely. The surgeon often removes the lesion down to the periosteum (the bone covering beneath the gum) to ensure all reactive tissue is eliminated and reduce recurrence risk. Pyogenic granulomas can sometimes resolve on their own after the irritating factor, such as pregnancy hormones, is removed.
To prevent recurrence, it is necessary to eliminate the underlying irritant that caused the initial growth. This involves professional dental cleaning to remove plaque and calculus, or adjusting ill-fitting dental restorations or dentures. While the prognosis is favorable, recurrence is possible if the causative factor is not fully addressed.