A benign gum tumor is called an epulis. It belongs to the group of tooth granulomas.
What is an epulis?
An epulis is a nodular, isolated tumor that grows on the gums and is benign in nature. The epulides are tissue growths that dentists also call granulomas.
The name Epulis comes from the Greek and means “on the gums”. The epulides have the shape of mushrooms or hemispheres and in most cases sit on the edge of the gums. In dentistry, the epulis is also known as focal fibrous hyperplasia. The origin of the tissue growth is usually mesenchymal. They rarely come from the epithelium.
The epulis is divided into several types:
- the epulis granulomatosa
- the epulis fibromatosa
- the epulis gigantocellularis
- the Epulis sarcomatodes
The epulis granulomatosa is a soft, nodular change that is light red to red and bleeds easily. Their shape is reminiscent of a hemisphere. The epulis granulomatosa grows on the edge of the gums. If it is on the neck of the tooth, recurrences are not uncommon. From a Epulis fibromatosa is mentioned when the lining of the gums modified and crude, is broad-based and pale.
The collagen-rich fiber strands create an even network. The epulis fibromatosa is considered a mature epulis granulomatosa form.
The epulis gigantocellularis is a peripheral giant cell granuloma. It is noticeable as a dark red, nodular change on the gums that is out of focus. It mostly arises in the region of the posterior teeth or on toothless alveolar ridges. The female sex is particularly affected by the epulis gigantocellularis. The epulis sarcomatodes is a rare form of epulis. Its name can be traced back to the proliferating connective tissue, which resembles a sarcoma.
Causes
The epulis represents granulation tissue that has different cell structures. The tumor formation is usually caused by chronic tooth inflammation that occurs in the region of the tooth root tip. Inflammation of the jaw can also lead to the formation of epuli. The same goes for mechanical stimuli.
Pregnancy epulis is a special form of epulis. It is also called Granuloma gravidarum. It comes about through the hormonal changes that occur during pregnancy. These hormonal changes have a negative effect on the oral cavity.
It has not yet been clarified whether the pregnancy epidemic is ultimately triggered by hormones such as estrogen or progesterone, a weakened immune defense or an imbalance in the oral flora. In Germany alone, two to ten percent of all pregnant women are affected by epulis. It usually shows up between the 2nd and 3rd month of pregnancy and can be associated with pregnancy gingivitis.
Symptoms, ailments & signs
In most cases, the development of an epulis is only noticed when the gums bleed or hurt when they are under pressure. Bleeding occurs very quickly in the context of an epulis. The growths bulge on the gums and can take on a pink or red-bluish color. Another feature of the epulis is the formation of nodules. The pain is more or less pronounced.
Diagnosis
If an epulis is suspected, a visit to the dentist is recommended. After describing the symptoms, the dentist carries out a thorough examination of the oral cavity. The mushroom-shaped granulomas can usually be easily seen with the naked eye, so that an X-ray is usually unnecessary. In addition, the dentist looks for possible caries lesions or defective fillings or crown margins.
In order to rule out a malignant growth, some tissue is removed, which is examined for its cell type in a laboratory. In most cases, the epulis takes a positive course after dental treatment, so that the patient no longer feels any discomfort. However, if remnants of the granuloma remain, there is a risk of relapse, so that renewed therapy is necessary.
Complications
Elevated fat levels in the blood can cause a number of complications as they damage blood vessels. These are based on deposits of cholesterol and other substances on the vessel walls, whereby the diameter becomes narrower over time. In addition, the vessel walls are becoming more and more rigid and porous. Arteriosclerotically changed vessels develop.
The specific complications include:
- Angina pectoris (chest tightness or tightness of the chest)
The heart muscle is no longer properly supplied with blood because the coronary vessels calcify. This heart attack is noticeable through a left-sided, boring pain in the chest area, which radiates into the left arm.
- Heart attack
This is caused by narrowing and calcification of one or more branches of the coronary arteries. If it comes to a complete closure, the associated area of the heart muscle dies due to the lack of blood supply. The resulting heart attack is life-threatening,
- stroke
If the brain is no longer supplied with blood properly or not at all due to a narrowing of the blood vessels, a stroke can occur in the worst case. On the other hand, blood vessels that have become porous can lead to hemorrhage in the brain. Depending on the areas affected, symptoms of paralysis, speech disorders or death can occur.
- Circulatory disorders in the legs
Deposits can cause the arteries in the legs to become so narrow that the blood supply is disrupted. There is an acute lack of oxygen. This initially leads to muscle pain and then to occlusive diseases.
If left untreated, epulis can cause various complications. First, the benign gum tumor causes bleeding and pain in the mouth. The affected gums are sensitive to pressure and usually swell immediately. This can cause problems with chewing and speaking.
In the long term, misalignments can develop from an untreated tumor. As the disease progresses, inflammatory nodules eventually form in the mouth. If these burst, it can lead to severe infections in the mouth and throat, but also to an enlargement of the original tumor. A malignant tumor or gigantocellular epulis can rarely develop from an epulis.
The latter spreads to the adjacent bone tissue in the course of the disease and almost always leads to further complications. In severe cases it is necessary to remove the surrounding teeth. In addition, cysts can form in the area of the jawbone and damage it. Treating an epulis requires removing parts of the tissue and bone. After the operation, bleeding may occur and excessive scarring may occur. The epulis rarely grows back and requires renewed treatment.
When should you go to the doctor?
If the gum bleeds or hurts when you press it, it is often an epulis. A doctor’s visit is required if the symptoms have not subsided after a few days. Anyone who notices tumors should contact the dentist immediately. Heavy bleeding, inflammation or injuries in the oral cavity must also be clarified immediately before any subsequent symptoms arise. If complications already arise – such as swallowing difficulties or problems with eating – a doctor’s appointment should be made as soon as possible.
People with chronic tooth infections or jaw infections are particularly prone to epulis. Likewise people who grind their teeth regularly or who recently injured themselves inside the mouth. It is best to seek medical advice if you belong to these risk groups. If the symptoms mentioned occur during pregnancy, there may be a pregnancy sepulis.
The same applies here: Consult a doctor as soon as possible and have the complaints examined. Depending on the severity, the dentist or an orthodontist can be involved. In the event of severe complaints, the emergency medical service should be contacted.
Treatment & Therapy
If an epulis causes symptoms, it is treated with a surgical procedure. The tumor is surgically removed. The patient is given a local anesthetic during the minor procedure. To prevent an epulis from developing again, a certain part of the bone and the periosteum should also be removed. The same applies to a special region of the periodontal fiber system.
Treatment of the tooth root or gum is sometimes necessary. In this way, the triggering inflammation can be suppressed. If this treatment is unsuccessful, which is rarely the case, the affected tooth must be extracted. Another step in therapy is the removal of tartar and concretions from adjacent teeth. If a relapse occurs, the neighboring tooth must also be treated.
If the patient has a gigantocellular epulis, additional treatment of the adjacent bone with a drill is required. The relapse rate in peripheral giant cell granuloma is very high. Depending on how extensive the wound turns out to be during the procedure, it either remains open or is sutured by the dentist. If it is a pregnancy sepulis, the end of the pregnancy is usually awaited. As a rule, the tumor then recedes by itself.
Outlook & forecast
An epulis often regresses spontaneously. Medical treatment is usually sufficient to remove the growth and minimize any side effects. The epulis regresses within a few days to weeks, with usually no pain or other symptoms. Large structures can cause bleeding and difficulty speaking. It can also lead to painful swellings and abnormal sensations.
In individual cases the epulis forms further growths which can appear on the entire face. Recurrences occur very rarely. In principle, however, the disease offers a good prognosis. If it is recognized and treated at an early stage, it should quickly subside without complications or long-term consequences being expected. Well-being is not necessarily impaired by the structure. Life expectancy is not reduced if the outcome is positive.
The prognosis is worse if the disease is malignant. This can lead to serious complications such as tumor formation. There is also an increased risk of relapse, which can occur months or years after treatment. The patient is therefore dependent on regular follow-up checks so that medical measures can be taken promptly in the event of a health problem.
Prevention
It is not possible to prevent the development of an epulis immediately. However, regular care of your teeth and oral cavity is important in order to counteract inflammation.
Aftercare
With Epulis, in most cases the person affected has only very limited measures or options for follow-up care. In this case, the person concerned is primarily dependent on a quick and comprehensive examination and diagnosis so that there are no further complications or complaints. The earlier a doctor is consulted for Epulis, the better the further course of this disease is usually also.
For this reason, early detection is in the foreground with this disease, so that a doctor should be consulted as soon as the first signs and symptoms appear. The treatment itself is usually carried out with the help of creams or medication, although in some cases interventions in the oral cavity are necessary in order to completely limit the symptoms of epulis.
However, the person concerned should generally ensure a high standard of hygiene. This includes brushing your teeth regularly and using a mouthwash. When taking medication, ensure that it is taken regularly and that the dosage is correct. As a rule, Epulis disease does not reduce the life expectancy of the person affected, and it also comes to a complete cure without complications.
You can do that yourself
An epulis is a benign gum tumor that is usually due to chronic inflammation of the tooth or gums. Such a tumor is not dangerous, but a person affected should nevertheless visit a dentist promptly in order to have the cause of the disorder treated. The underlying disease can lead to significant complications, including tooth loss.
The patient cannot contribute much to the treatment of the tumor itself. However, it can prevent the most common underlying diseases by taking a number of measures. Above all, good oral hygiene is important. The teeth should be cleaned at least in the morning and in the evening, but preferably after every meal. Toothbrushes are the perfect breeding ground for bacteria because they are constantly moist, tiny food residues get caught in the bristles and they are usually stored in a well-heated bathroom.
Toothbrushes with high microbial contamination can exacerbate an existing inflammation in the oral cavity. The instruments should therefore be cleaned thoroughly after each use and finally rinsed with cold water. Toothbrushes also need to be replaced regularly. Oral hygiene can be significantly improved by using mouthwash and floss.
In addition, regular check-ups with the dentist are necessary so that diseases of the teeth and gums can be detected and treated before serious damage to the tooth or other complications occurs.
