A large-cohort study of 2971 cases of epulis: focusing on risk factors associated with recurrence

Na Zhao, Yelidana Yesibulati, Pareyida Xiayizhati, Yi-Ning He, Rong-Hui Xia, Xiang-Zhen Yan, Na Zhao, Yelidana Yesibulati, Pareyida Xiayizhati, Yi-Ning He, Rong-Hui Xia, Xiang-Zhen Yan

Abstract

Background: To analyze the clinicopathological features of different histological subtypes of epulis, and evaluate the risk factors associated with recurrence.

Materials and methods: A retrospective study including 2971 patients was performed. The patients' sex, age, location, size, histological subtypes, recurrence information, oral hygiene habits, periodontitis symptoms and smoking history were retrieved from the patient medical records and follow-up information.

Results: Among the 2971 cases, focal fibrous hyperplasia (FFH) was the most common lesion (60.92%), followed by peripheral ossifying fibroma (POF) (29.32%), pyogenic granuloma (PG) (8.08%) and peripheral giant cell granuloma (PGCG) (1.68%). The peak incidence of epulis was in the third and fourth decade of life, with a mean age of 45.55 years. Female predominance was found in all types of lesions with a female to male ratio of 1.71:1. PG had the highest recurrence rate (17.18%), followed by POF (12.98%), FFH (9.55%) and PGCG (8.82%). Histological subtypes were significantly correlated with the recurrence of epulis (P = 0.013). Regular supportive periodontal therapy (P = 0.050) had a negative correlation with recurrence, whereas symptoms of periodontitis (P < 0.001) had a positive correlation with the recurrence of epulis.

Conclusions: Controlling the periodontal inflammation and regular supportive periodontal therapy might help reduce the recurrence of epulis.

Keywords: Clinicopathological features; Epulis; Histological subtypes; Recurrence; Risk factors.

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
Demographic and clinical features of 2971 cases of epulis. (A) Sex and age distribution of 2971 patients. Epulis had predilection for females and the peak incidence was in the third and fourth decade of life. (B) Epulis had a slight tendency to occur in anterior region and maxilla. (C) The size of most cases was between 0.6 to 1.5 cm
Fig. 2
Fig. 2
Representative photomicrographs of four histological subtypes of epulis. (A) FFH consists of bundles of dense collagen fibers with limited inflammation. (B) Cellular fibrous tissue hyperplasia with mineralization presents in POF. (C) PG is characterized with the proliferation of endothelial cells and a large amount of inflammatory cell. The lesion is covered by an ulcerated thin layer of stratified squamous epithelium. (D) PGCG exhibits focal nodules of multinucleated osteoclast-like cells. Hematoxylin and eosin (H&E) staining, scale bar: 100 μm. Insert: enlarged images

References

    1. Buchner A, Shnaiderman-Shapiro A, Vered M. Relative frequency of localized reactive hyperplastic lesions of the gingiva: a retrospective study of 1675 cases from Israel. J Oral Pathol Med. 2010;39(8):631–8. doi: 10.1111/j.1600-0714.2010.00895.x.
    1. Buchner A, Calderon S, Ramon Y. Localized hyperplastic lesions of the gingiva: a clinicopathological study of 302 lesions. J Periodontol. 1977;48(2):101–4. doi: 10.1902/jop.1977.48.2.101.
    1. Kfir Y, Buchner A, Hansen LS. Reactive lesions of the gingiva. A clinicopathological study of 741 cases. J Periodontol. 1980;51(11):655–61. doi: 10.1902/jop.1980.51.11.655.
    1. Zhang W, Chen Y, An Z, Geng N, Bao D. Reactive gingival lesions: a retrospective study of 2,439 cases. Quintessence international (Berlin, Germany: 1985). 2007;38(2):103 – 10.
    1. Effiom OA, Adeyemo WL, Soyele OO. Focal reactive lesions of the Gingiva: an analysis of 314 cases at a tertiary Health Institution in Nigeria. Nigerian Med journal: J Nigeria Med Association. 2011;52(1):35–40.
    1. Soyele OO, Ladeji AM, Adebiyi KE, Adesina OM, Aborisade AO, Olatunji AS, et al. Pattern of distribution of reactive localised hyperplasia of the oral cavity in patients at a tertiary health institution in Nigeria. Afr Health Sci. 2019;19(1):1687–94. doi: 10.4314/ahs.v19i1.45.
    1. Babu B, Hallikeri K. Reactive lesions of oral cavity: a retrospective study of 659 cases. J Indian Soc Periodontology. 2017;21(4):258–63.
    1. Truschnegg A, Acham S, Kiefer BA, Jakse N, Beham A. Epulis: a study of 92 cases with special emphasis on histopathological diagnosis and associated clinical data. Clin Oral Investig. 2016;20(7):1757–64. doi: 10.1007/s00784-015-1665-3.
    1. Narwal A, Bala S. Osteopontin expression and clinicopathologic correlation of oral hyperplastic reactive lesions: an institutional 6-year retrospective study. J Oral Maxillofac Pathol. 2017;21(3):382–6. doi: 10.4103/jomfp.JOMFP_231_15.
    1. Reddy V, Bhagwath SS, Reddy M. Mast cell count in oral reactive lesions: a histochemical study. Dent Res J. 2014;11(2):187–92.
    1. Dutra KL, Longo L, Grando LJ, Rivero ERC. Incidence of reactive hyperplastic lesions in the oral cavity: a 10 year retrospective study in Santa Catarina, Brazil. Braz J Otorhinolaryngol. 2019;85(4):399–407. doi: 10.1016/j.bjorl.2018.03.006.
    1. Draghici EC, CraiToiu S, Mercu TV, Scrieciu M, Popescu SM, Diaconu OA, et al. Local cause of gingival overgrowth. Clinical and histological study. Rom J Morphol Embryol. 2016;57(2):427–35.
    1. Savage NW, Daly CG. Gingival enlargements and localized gingival overgrowths. Aust Dent J. 2010;55(Suppl 1):55–60. doi: 10.1111/j.1834-7819.2010.01199.x.
    1. Dawes C. Why does supragingival calculus form preferentially on the lingual surface of the 6 lower anterior teeth? J Can Dent Assoc. 2006;72(10):923–6.
    1. Hayashizaki J, Ban S, Nakagaki H, Okumura A, Yoshii S, Robinson C. Site specific mineral composition and microstructure of human supra-gingival dental calculus. Arch Oral Biol. 2008;53(2):168–74. doi: 10.1016/j.archoralbio.2007.09.003.
    1. Reddy V, Saxena S, Saxena S, Reddy M. Reactive hyperplastic lesions of the oral cavity: a ten year observational study on North Indian Population. J Clin Exp Dent. 2012;4(3):e136–40. doi: 10.4317/jced.50670.
    1. Maturana-Ramirez A, Adorno-Farias D, Reyes-Rojas M, Farias-Vergara M, Aitken-Saavedra J. A retrospective analysis of reactive hyperplastic lesions of the oral cavity: study of 1149 cases diagnosed between 2000 and 2011, Chile. Acta Odontol Latinoam. 2015;28(2):103–7.
    1. Lakkam BD, Astekar M, Alam S, Sapra G, Agarwal A, Agarwal AM. Relative frequency of oral focal reactive overgrowths: an institutional retrospective study. J Oral Maxillofac Pathol. 2020;24(1):76–80. doi: 10.4103/jomfp.JOMFP_350_19.
    1. Kadeh H, Saravani S, Tajik M. Reactive hyperplastic lesions of the oral cavity. Iran J Otorhinolaryngol. 2015;27(79):137–44.
    1. Daley TD, Wysocki GP, Wysocki PD, Wysocki DM. The major epulides: clinicopathological correlations. J Can Dent Assoc. 1990;56(7):627–30.
    1. Yadav RK, Verma UP, Tiwari R. Non-invasive treatment of pyogenic granuloma by using Nd:YAG laser. BMJ Case Rep. 2018;2018.
    1. Andrikopoulou M, Chatzistamou I, Gkilas H, Vilaras G, Sklavounou A. Assessment of angiogenic markers and female sex hormone receptors in pregnancy tumor of the gingiva. J oral maxillofacial surgery: official J Am Association Oral Maxillofacial Surg. 2013;71(8):1376–81. doi: 10.1016/j.joms.2013.03.009.
    1. Wu M, Chen SW, Su WL, Zhu HY, Ouyang SY, Cao YT, et al. Sex hormones enhance gingival inflammation without affecting IL-1beta and TNF-alpha in Periodontally Healthy women during pregnancy. Mediators Inflamm. 2016;2016:4897890. doi: 10.1155/2016/4897890.
    1. Krishnapillai R, Punnoose K, Angadi PV, Koneru A. Oral pyogenic granuloma–a review of 215 cases in a south indian Teaching Hospital, Karnataka, over a period of 20 years. Oral Maxillofac Surg. 2012;16(3):305–9. doi: 10.1007/s10006-012-0315-z.
    1. Fonseca GM, Fonseca RM, Cantín M. Massive fibrous epulis-a case report of a 10-year-old lesion. Int J Oral Sci. 2014;6(3):182–4. doi: 10.1038/ijos.2013.75.
    1. Jiang Y, Fang B, Xu B, Chen L. The RAS-PI3K-AKT-NF-kappaB pathway transcriptionally regulates the expression of BCL2 family and IAP family genes and inhibits apoptosis in fibrous epulis. J Clin Lab Anal. 2020;34(3):e23102. doi: 10.1002/jcla.23102.
    1. Sarwal P, Lapumnuaypol K. Pyogenic Granuloma. StatPearls. Treasure Island (FL)2022.
    1. Vara JT, Gurudu VS, Ananthaneni A, Bagalad BS, Kuberappa PH, Ponnapalli HP. Correlation of vascular and inflammatory index in oral pyogenic Granuloma and Periapical Granuloma - An Insight into Pathogenesis. J Clin Diagn research: JCDR. 2017;11(5):Zc25–zc8.
    1. Okada H, Tsutsumi A, Imai M, Nakajima T, Yasuda K, Kanzaki H. Estrogen and selective estrogen receptor modulators regulate vascular endothelial growth factor and soluble vascular endothelial growth factor receptor 1 in human endometrial stromal cells. Fertil Steril. 2010;93(8):2680–6. doi: 10.1016/j.fertnstert.2009.08.056.
    1. Motamedi MH, Eshghyar N, Jafari SM, Lassemi E, Navi F, Abbas FM et al. Peripheral and central giant cell granulomas of the jaws: a demographic study. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2007;103(6):e39-43.
    1. Kadeh H, Derakhshanfar G, Saravani S. Comparative study of mast cell count in oral reactive lesions and its association with inflammation. Turk patoloji dergisi. 2016;32(1):22–6.
    1. Sundararajan A, Muthusamy R, Gopal Siva K, Harikrishnan P, Kumar SCK, Rathinasamy SK. Correlation of Mast Cell and Angiogenesis in Oral Lichen Planus, Dysplasia (Leukoplakia), and Oral Squamous Cell Carcinoma.Rambam Maimonides Med J. 2021;12(2).
    1. Verma PK, Srivastava R, Baranwal HC, Chaturvedi TP, Gautam A, Singh A. Pyogenic granuloma - hyperplastic lesion of the gingiva: case reports. The open dentistry journal. 2012;6:153–6. doi: 10.2174/1874210601206010153.
    1. Echeverria JJ, Manau GC, Guerrero A. Supportive care after active periodontal treatment: a review. J Clin Periodontol. 1996;23(10):898–905. doi: 10.1111/j.1600-051X.1996.tb00509.x.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe