20 January 2023

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Epulides: factors associated with their recurrence

Lara Figini

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Epulides are characterized by hyperplastic growth of gingival tissues, predominantly at the level of the interdental papilla. These lumps on the gums are typically caused due to poor oral hygiene, microorganisms, poor adherence and poor fit of appliances and restorations.

Epulides have a high recidivism rate ranging up to 20%. Several published studies have shown that the recurrence rate of epulis after surgical removal is still high today.

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

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

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

Materials, 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 the clinicopathological characteristics.

Researchers identified data from 211 patients with a clinicopathologic 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 evaluate associations between distinct characteristics and recurrence. Stratified analyzes by sex were applied to identify the different associations.

Results

Binary logistic regression showed that patients with ulcerated lesions or with local mechanical stimulation had a higher risk of developing recurrence.

Stratified analysis of sex identified a significant association with female sex. 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 of this study, it can be concluded that patients with ulcerated lesions and local mechanical stimulation may have an elevated risk of developing recurrent epulis. Researchers said that clinicians should pay more attention to patients with ulcer and mechanical stimulation. Apart from complete surgical removal, it is important to remove local stimulation to prevent recurrence of these lesions.

For more information, see: "Clinical and pathologic factors associated with the relapse of fibrous gingival hyperplasia."