Epulis fissuratum (Inflammatory fibrous hyperplasia)
DESCRIPTION: This lesion occurs in those who wear prosthetic appliances. The lesion consists of two or more folds of soft tissue separated by a central groove into which fits the appliance border. It most often is found in the buccal vestibule of the anterior maxilla, but any mucosal area touched by a denture border is vulnerable including the lingual aspect of the mandible. In a study of 583 cases, 64% were found in females.
Those in the fifth and sixth decade are most often affected. Duration ranged from one week to 10 years, 40% of the patients reported a duration of 6 months to two years. Symptoms are absent except in ulcerated lesions which may be painful. Histologically, the excessive tissue is composed of cellular, inflamed fibrous connective tissue.
ETIOLOGY: This is an inflammatory fibrous hyperplasia or oral mucosa caused by ill-fitting or over-extended denture borders.
TREATMENT: Surgical excision of the lesion and reduction of the denture border.
PROGNOSIS: Good
DIFFERENTIAL DIAGNOSIS: The lesion has such a characteristic clinical appearance that differential diagnosis is not a problem. Persistent ulcerated areas in epulis fissuratum should be biopsied to rule out squamous carcinoma. Folds similar to epulis fissuratum may be seen in Crohn’s disease.
