Epulis fissuratum is a mucosal hyperplasia that results from chronic low-grade trauma induced by a denture flange.[1] Epulis fissuratum is analogous to acanthoma fissuratum of skin.
Epulis fissuratum arises in association with denture flanges. Consequently, epulis fissuratum is usually observed in the maxillary or mandibular vestibule.
A study on the prevalence of oral lesions among 210 denture wearers found that oral lesions were found in 20.5% of the cases and that denture-induced fibrous hyperplasia was the most common type of lesion detected (41.9%).[2]
Significant morbidity does not occur with epulis fissuratum.
Most studies indicate a clear predilection for epulis fissuratum in females.[3] Possible atrophic epithelial changes secondary to menopause may influence an increased reaction to trauma in older females.
Epulis fissuratum occurs in greatest numbers in the fifth, sixth, and seventh decades, but it can be observed at almost any age. Epulis fissuratum has been described in children. The fact that the lesions are related to denture wear and chronicity of an irritative process explains the higher incidence in older individuals.
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View Image | An epulis fissuratum in the anterior part of the mandible shows a central groove where the denture flange rests. Note the inflammatory erythema. The s.... |
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Epulis fissuratum is a hyperplastic reactive lesion, often with inflammatory and reparative phases. The histologic picture can be variable.[7] Most frequently, a dense fibrous hyperplasia occurs, often with varying degrees of inflammation and vascularity. Because capillary proliferation is considerable, an overlap with pyogenic granuloma occurs. Mucous glands are often present in the specimen and may show a chronic sialadenitis. Occasionally, the glands may have an associated lymphoid hyperplasia and papillary ductal hyperplasia. The epithelium may be atrophic or hyperplastic and occasionally shows a pseudoepitheliomatous hyperplasia. Ulceration can occur. Infrequently, chondroid or osseous metaplasia can develop within the mass.
View Image | A view of a whole mount of a tissue section taken from an epulis fissuratum shows that it is essentially a fibrous hyperplasia. The central groove can.... |
Surgically excise the epulis fissuratum because even removal of the offending stimulus (ie, denture) will not result in complete resolution. In addition, correct the denture; otherwise, the lesion will recur. Either make a new denture or reline the old denture. The use of laser therapy is discussed in recent studies.[8, 9, 10]
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