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What are Epulides?

An Epulis is a ‘lump on the gum’. Epulides are the most common type of lump on the gum and can best be described as long-term inflamed hyperplasia (an excessive growth of normal cells).

Epulides come in a number of forms – fibrous epulides, pyogenic granulomata, giant-cell granulomata and denture granuloma / hyperplasia.

They are caused by trauma (repeated chewing of a lip or tongue) and long-term irritation or friction by such things as badly fitting dentures, fillings and crowns, plaque and rough tooth edges.

In more than 80% cases, an epulis will form in front of the molars (large back teeth) and they are more common on the upper jaw than the lower. Epulides are more common in women than in men.

Photo of a Pregnancy Epulis in the inter-proximal area of the UR3 – UR4

Fibrous Epulides

These growths can appear as either a flat mass or have a ‘stalk’.

They are normally the same colour and texture as the gum around the growth but the surface of the epulis may be ulcerated and covered by a yellow, fibrous membrane.

This type of epulis affects a wide age range of people but most patients are between 11 and 40-years old.

Vascular Epulides (Pyogenic Granuloma & Pregnancy Epulis)

Under the microscope, the Pyogenic Granuloma and the Pregnancy Epulis look the same.

They appear as soft, deep reddish-purple swellings and are often ulcerated. They are found mostly on the gums but can also be seen on the tongue, cheek and lips as a result of trauma. They may bleed, either spontaneously or if they are touched or knocked.

Photo of Pyogenic Granulomata
Photo of Pyogenic Granulomata

Pregnancy epulides can arise anytime during pregnancy. While they may often recur (despite removal) during the pregnancy, they may disappear after the baby is born.

After the birth, some pregnancy epulides will become fibrous epulides.

How are they treated?

They are surgically removed under Local Anæsthetic as in a biopsy.

Useful Articles & Websites

Wikipedia (Pyogenic Granuloma)

Wikipedia (Epulis)

Simply Teeth

DermNet NZ (Pyogenic Granuloma)

DermNet NZ (Epulis) (Oral Fibromata & Fibromatoses)

Emedicine (Oral Pyogenic Granuloma)

Maj Ked Gigi (Dent J) 2005. Epulis & Pyogenic Granuloma with Occlusal Interference

J Oral Sci 2006. Oral Pyogenic Granuloma – A Review

BJOMS 2009. Short communication. Oral Pyogenic Granuloma. A review of 137 cases

Open Dent J 2012. Pyogenic Granuloma – Hyperplastic Lesion of the Gingiva. Case Reports

Ind J Multidisciplinary Dent 2012. Case Reports. Pregnancy Epulis

BAD Guidelines 2013. Pyogenic Granuloma 2013. Pyogenic Granuloma

Dentistry 2014. Case Reports. Oral Pyogenic Granuloma after Tongue Piercing Use – Case Report

Int J Oral Sci 2014. Case Report. Massive Fibrous Epulis – A Case Report of a 10-Year-Old Lesion

Case Rep Oncol 2015. Alternative Therapeutic Approach in the Treatment of Oral Pyogenic Granuloma

World J Clin Cases 2015. Gingival Enlargements – Differential Diagnosis & Review of Literature

J Dent Med Sci 2016. Clinicopathological Characteristics of Oral Pyogenic Granuloma – A Comparative Study

Eur Sci J 2017. Fibroma of Buccal Mucosa – Case Report & Literature Review

Adv Dent & Oral Health 2018. Surgical Excision of an Epulis – Case Report

J Ind Acad Oral Med Radiol 2018. Conservative Approach in the Management of Oral Pyogenic Granuloma by Sclerotherapy

Dental Update 2019. A Case of Florid Pregnancy Gingivitis

Int J Appl Dent Sci 2019. Management of a Pyogenic Granuloma of the Tongue – A Case Report & Review of the Literature

J IMAB 2019. Pyogenic Granulomas in the Oral Cavity – A Series of Cases