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Localized gingival overgrowths (LGOs) encompass a category of oral lesions that are commonly encountered in dental practice. The authors report three cases of gingival epulides and also review the various conditions (both local and systemic) in which LGOs have been reported to occur. A flowchart is also proposed for a systematic approach to aid diagnosis. Although most epulides are hyperplastic lesions, rare conditions clinically identical to inflammatory or reactive LGOs do occur. Their innocuous appearance may frequently deceive the dental practitioner.
Clinical Relevance: Knowledge of various lesions that could present as an LGO is necessary and significant, as prompt diagnosis and specialist referral influences the treatment plan.
Article
Occurrence of a LGO can indicate many conditions, both local and systemic, ranging from regular hyperplastic reactive lesions1 to atypical metastatic neoplasms.2 A non-specific term ‘epulis’ (literally, ‘on the gingiva’) is commonly used to describe any such circumscribed overgrowths on the gingiva. However, as this description refers only to the site and does not provide any indication about the nature of the lesion, a clinical diagnosis of ‘epulis’ must be replaced with a more definitive diagnosis after biopsy and histopathologic evaluation.3,4,5,6
A review of the literature shows that many rare lesions have manifested as asymptomatic epulides. Meleti et al6 reported a case of primary squamous cell carcinoma on the gingiva that clinically mimicked a fibrous epulis. Cases of metastases from breast7 and lung carcinoma,8 bearing clinical resemblance to a gingival pyogenic granuloma, have also been published. Intramucosal nevi and oral melanoma presenting as circumscribed soft tissue masses on the gingiva were reported by Suzuki et al9 and De Vicente et al,10 respectively. Thus, in practice, the final diagnosis of an epulis may range from benign to potentially lethal lesions, although most epulides are fibrous reactive lesions.4
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