Author
Information
Ranjana Desai*, Nalini Jangid**, Rashmi
Sharma***, Kiran Mirdha****
(*Professor, **3rd year P.G. Resident, Department
of Obstetrics and Gynaecology; ***Assistant Professor, Department of Pathology;
****Medical Officer, Department of Obstetrics and Gynaecology; Dr. Sampoornanand
Medical College, Jodhpur)
Abstract
Epulis
of pregnancy is a benign growth of the gingiva with a rare occurrence during
pregnancy. This is a report of a case of epulis during pregnancy which showed
spontaneous regression after delivery.
Introduction
Epulis
fissuratum or Granuloma fissuratum is an oral pathologic hyperplastic condition
that appears in the mouth as an overgrowth of fibrous connective tissue mainly
from gingivial tissues.[1] When it is associated with the edges of
an ill fitting denture it is referred to as Inflammatory fibrous hyperplasia, Denture
epulis or Denture induced fibrous hyperplasia. Epulis in a patient without
dentures can also be diagnostic of Crohn's disease.[2]
Its occurrence in a pregnant woman is termed
Epulis of Pregnancy or Granuloma gravidarum. Since it is rare during pregnancy
and because its prevalence in pregnancy has not been well documented, the
present case merits attention.
Case Report
A 24 year old third gravida with two full
term normal deliveries presented to our antenatal clinic with amenorrhea of 7
months duration. While taking her history it was noted that she had an
irregular fleshy growth over her teeth. On everting her upper lip and examining
the gums of the upper jaw, a 2 centimeters long irregular fleshy mass was
detected arising from the gums and growing over and between her incisor teeth (figure
1). On examining the oral cavity the lesion extended 3 centimeters posteriorly
on the soft palate (figure 2). The lesion was firm to touch, non-tender.
History revealed that the growth had slowly evolved from a small size to the
present one over a period of 2 months. The lesion was asymptomatic and the
patient refused a biopsy. A clinical diagnosis of epulis of pregnancy was made.
No surgical intervention was advised and only oral hygiene in the form of mouth
wash with a commercially available over-the-counter mouth wash consisting of an aqueous solution
containing bezoic acid, poloxamer 407, eucalyptol, thymol, sodium benzoate, and
menthol mixed in alcohol twice a day and regular brushing of teeth twice daily
was recommended. One month after delivery the mass had spontaneously regressed
to half its size. And two months after delivery the lesion was one fourth its
former size. After this the patient was lost to follow up.
Figure
1 : Anterior view of the epulis. Note the irregular fleshy growth emerging from
between the incisors.
Figure
2 : Buccal view of the epulis. Note the dumbbell shape of the tumor displacing
the incisors.
Discussion
Epulis
of pregnancy (synonyms: pregnancy tumor, granulaoma gravidarum, pyogenic
Granuloma) is described as a gingival lesion that looks like a small, dome
shaped hemangioma, often with a peripheral collarette of scales. The excess
tissue is firm and fibrous; ulcerations may be present. It is usually
pedunculated but may be sessile. It appears in gums around the alveolar
vestibule, in either the mandible or maxilla (upper jaw) but is more commonly
found in the frontal part of the maxilla during the third trimester. Often it
has been referred to as pyogenic granulaoma in medical literature but the term
is a misnomer, for this is not an infectious or pustular process.
The
lesion is usually asymptomatic but appears cosmetically unsightly. It may
interfere with mastication, closure of the oral cavity, brushing or flossing. The
teeth adjacent to the epulis may loosen due to the pressure effect or may show
migration.[3] Sometimes there may be recurrent bleeding from the
lesion resulting in life threatening hemorrhage requiring blood transfusion.[4]
Etiologic
factors responsible for epulis of pregnancy are improper maintenance of oral
hygiene which leads to chronic gingivitis and the influence of hormones by a
complex and partly understood mechanism on the gingival vasculature.[5,6]
Epulis
has several histologic types. Granulomatous type is the prevalent type during
pregnancy. It presents an inflammatory component characterized by lymphocytes, plasma
cells and neutrophiles, an abundant vascular component with newly formed
capillaries and a great proliferation of fibroblasts.[7]
The
lesion usually resolves partially or completely post partum within 1 to 4 months[3]
as it did in this case reported. Persistent lesion requires treatment by
firstly removal of irritating factors and secondly surgical excision of the
lesion, curettage, chemical or electric cauterization, cryo therapy or laser
ablation.[5]
References
1. Niville BW, Damm DD, Allen CM, Bouqout JE. Oral and maxillofacial Pathology,
2nd edition, Philadelphia, W B saunders, 2002, 437- 495.
2. Budtz-Jorgensen E. Oral mucosal lesions associated with wearing of
removable dentures. J oral pathol 1981;10:65-80.
3. Orosz M, Szende B, Gábris K. The clinical and pathological symptoms of
pregnancy epulis. Fogorv Sz. 2007 Oct; 100(5):237-41, 233-6.
4. Adeyemo WL, Ladeinde AL, Ajayi OF, Umeizudike K, et al. Pregnancy
epulis associated with life threatening haemorrhage in a Nigerian woman. Nig Q
J Hosp Med. 2010 Jan-Mar; 20(1):10-2.
5. Saravanum T, Shakila KR, Shanthini K. Pregnancy Epulis, Ind J of Multidiscp Dentistry. 2012;2(3):514-17.
6. Rabinerson D, Kaplan B, Dicker D, Dekel A. Epulis during pregnancy. Harefuah. 2002 Sep;
141(9):824-6.
7. Tumini V, Di Placido G,
D'Archivio D, et al. Hyperplastic
gingival lesions in pregnancy. I. Epidemiology, pathology and clinical aspects.
Minerva Stomatol. 1998 Apr; 47(4):159-67.
Citation
Desai R, Jangid N, Sharma R, Mirdha K. Epulis of Pregnancy. JPGO Volume 1 Issue 3, March 2014, available at: http://www.jpgo.org/2014/03/epulis-of-pregnancy.html