eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Epulis Fissuratum

Author: Diane Stern, DDS, Clinical Professor, Department of Surgery, Section of Oral and Maxillofacial Surgery, University of Miami; Clinical Professor, Nova Southeast University School of Dental Medicine
Contributor Information and Disclosures

Updated: Jul 6, 2009

Introduction

Background

Epulis fissuratum is a mucosal hyperplasia that results from chronic low-grade trauma induced by a denture flange.1  Epulis fissuratum is analogous to acanthoma fissuratum of skin.

Pathophysiology

Epulis fissuratum arises in association with denture flanges. Consequently, epulis fissuratum is usually observed in the maxillary or mandibular vestibule.

Mortality/Morbidity

Significant morbidity does not occur with epulis fissuratum.

Race

Most cases of epulis fissuratum are observed in whites. This, no doubt, relates to the predominance of whites as denture wearers.

Sex

Most studies indicate a clear predilection for epulis fissuratum in females.2 The fact that women are more likely than men to wear their dentures for prolonged periods because of their reluctance to be seen without them probably plays a significant role. In addition, more women than men wear dentures and are more likely to seek treatment. Possibly, atrophic epithelial changes secondary to menopause may influence an increased reaction to trauma in older females.

Age

Epulis fissuratum occurs in greatest numbers in the fifth, sixth, and seventh decades, but it can be observed at almost any age. Epulis fissuratum has been described in children. The fact that the lesions are related to denture wear and chronicity of an irritative process explains the higher incidence in older individuals.

Clinical

History

  • Epulis fissuratum develops slowly over a prolonged period of time in patients with ill-fitting dentures. It is associated with a denture flange that may be either a full or partial denture.3
  • Typically, patients with epulis fissuratum are asymptomatic.4

Physical

  • Examination of an epulis fissuratum patient typically reveals folds of hyperplastic mucosa, which encompass the border of the denture flange. The edge of the denture usually fits in a groove between the folds. The lesions are most frequently observed at the facial aspect of the denture. The occurrence of this on the lingual surface is unusual. They are more often observed in the anterior portion of the jaws; however, a predilection for the maxilla or the mandible does not seem to exist.
  • The surface of the epulis fissuratum mass tends to be smooth; however, occasionally, it is ulcerated (most often within the depth of the groove) or papillary.
  • The size of the epulis fissuratum lesion is variable; some lesions are small, but they can be extensive and involve the entire length of the vestibule.5
  • Although frequently of normal mucosal color, erythema may be associated with inflammation. Some lesions have a more pyogenic granuloma –like appearance because of capillary proliferation.


An epulis fissuratum in the anterior part of the ...

An epulis fissuratum in the anterior part of the mandible shows a central groove where the denture flange rests. Note the inflammatory erythema. The surface of the lesion is usually smooth as shown in the image.

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An epulis fissuratum in the anterior part of the ...

An epulis fissuratum in the anterior part of the mandible shows a central groove where the denture flange rests. Note the inflammatory erythema. The surface of the lesion is usually smooth as shown in the image.

Causes

  • The cause of epulis fissuratum is chronic low-grade irritation from an ill-fitting denture. Frequently, this is the consequence of resorption of the alveolar ridge so that the denture moves further into the vestibular mucosa, creating an inflammatory fibrous hyperplasia that proliferates over the flange.3

More on Epulis Fissuratum

Overview: Epulis Fissuratum
Differential Diagnoses & Workup: Epulis Fissuratum
Treatment & Medication: Epulis Fissuratum
Follow-up: Epulis Fissuratum
Multimedia: Epulis Fissuratum
References
Further Reading
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References

  1. Bhattacharyya I. Case of the month. Epulis fissuratum. Todays FDA. Jul 2008;20(7):15, 17, 19. [Medline].

  2. Buchner A, Begleiter A, Hansen LS. The predominance of epulis fissuratum in females. Quintessence Int. Jul 1984;15(7):699-702. [Medline].

  3. Coelho CM, Zucoloto S, Lopes RA. Denture-induced fibrous inflammatory hyperplasia: a retrospective study in a school of dentistry. Int J Prosthodont. Mar-Apr 2000;13(2):148-51. [Medline].

  4. Keng SB, Loh HS. Clinical presentation of denture hyperplasia of oral tissues. Ann Acad Med Singapore. Sep 1989;18(5):537-40. [Medline].

  5. Ralph JP, Stenhouse D. Denture-induced hyperplasia of the oral soft tissues. Vestibular lesions, their characteristics and treatment. Br Dent J. Jan 18 1972;132(2):68-70. [Medline].

  6. Cutright DE. The histopathologic findings in 583 cases of epulis fissuratum. Oral Surg Oral Med Oral Pathol. Mar 1974;37(3):401-11. [Medline].

  7. Naveen Kumar J, Bhaskaran M. Denture-induced fibrous hyperplasia. Treatment with carbon dioxide laser and a two year follow-up. Indian J Dent Res. Jul-Sep 2007;18(3):135-7. [Medline].

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Keywords

epulis fissuratum, denture-induced hyperplasia, inflammatory hyperplasia, denture hyperplasia, denture-induced fibrous hyperplasia

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Contributor Information and Disclosures

Author

Diane Stern, DDS, Clinical Professor, Department of Surgery, Section of Oral and Maxillofacial Surgery, University of Miami; Clinical Professor, Nova Southeast University School of Dental Medicine
Disclosure: Nothing to disclose.

Medical Editor

Marjan Garmyn, MD, PhD, Professor, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium; Chair and Adjunct Head, Department of Dermatology, University of Leuven, Belgium
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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