16 February 2023

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Dental epulis: factors associated with its recurrence

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The épulis is characterized by a hyperplastic growth of gingival tissues, predominantly at the level of the interdental papilla. These gum lumps are usually due to poor oral hygiene, microorganisms, poor adhesion, and poor fit of appliances and restorations.

Épulis have a high recidivism rate up to 20%. Several published studies have shown that the recurrence rate of the épulis after surgical removal remains high today.

Surgeons are often faced with the trade-off between a conservative resection of the lesion, to avoid an unsightly residual gingival defect with increased root exposure, or a wide resection of the épulis that can more easily prevent recurrence. Conservative local resection is usually the preferred treatment, which may explain the high rate of recurrence.

Fibrous epulis is a fibrous hyperplasia of the gum and consists of bundles of collagen fibers and fibroblasts of various proportions arranged irregularly. Peripheral ossifying fibroma, or POF, usually indicates fibrous epulis, which shows areas of calcification or ossification. There are four types of calcifications in POF: dystrophic bone, immature, mature (lamellar) bone, and cementum.

Previous studies of the literature have shown that different types of calcifications can have various effects on recurrence.

Materials and methods

In a retrospective clinical study published in December 2022 in the Journal of the American Dental Association, the authors identified risk factors associated with recurrence of fibrous gingival hyperplasia based on clinicopathological features.

The researchers identified data from 211 patients with a clinicopathological diagnosis of fibrotic gingival hyperplasia. PI patients who relapsed after surgical excision of the lesion were considered case reports (n = 30). All patients in the control group had no recurrence (n = 181).

The research team used logistic regression to assess associations between different characteristics and recurrence. Sex-stratified analyses were applied to identify different associations.

Results

Binary logistic regression showed that patients with ulcerated lesions or local mechanical stimulation were at increased risk of developing recurrence.

Stratified sex analysis identified a significant association with females. Data from this study showed that male patients with larger epulis developed fewer recurrences. There was no significant difference in pathological calcification between the two groups of patients.

Conclusions

From the data in this study, it can be concluded that patients with ulcerated lesions and local mechanical stimulation may have an elevated risk of developing recurrent epulis. The researchers said doctors should pay more attention to patients with ulcer and mechanical stimulation. In addition to complete surgical removal, it is important to remove local stimulation to prevent recurrence of these lesions.

For more information see: "Clinical and pathological factors associated with the recurrence of fibrous gingival hyperplasia."

This article was originally published on Odontologia33.