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Epulis Fissuratum

  • Author: Diane Stern, DDS; Chief Editor: William D James, MD  more...
 
Updated: Mar 18, 2014
 

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.

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Pathophysiology

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

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Epidemiology

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.

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Contributor Information and Disclosures
Author

Diane Stern, DDS 

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

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, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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.

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

  2. Buchner A, Begleiter A, Hansen LS. The predominance of epulis fissuratum in females. Quintessence Int. 1984 Jul. 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. 2000 Mar-Apr. 13(2):148-51. [Medline].

  4. Keng SB, Loh HS. Clinical presentation of denture hyperplasia of oral tissues. Ann Acad Med Singapore. 1989 Sep. 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. 1972 Jan 18. 132(2):68-70. [Medline].

  6. Cutright DE. The histopathologic findings in 583 cases of epulis fissuratum. Oral Surg Oral Med Oral Pathol. 1974 Mar. 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. 2007 Jul-Sep. 18(3):135-7. [Medline].

  8. de Arruda Paes-Junior TJ, Cavalcanti SC, Nascimento DF, Saavedra Gde S, Kimpara ET, Borges AL, et al. CO(2) Laser Surgery and Prosthetic Management for the Treatment of Epulis Fissuratum. ISRN Dent. 2011. 2011:282361. [Medline]. [Full Text].

 
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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.
The mass in the posterior part of the maxillary vestibule is associated with a full denture; however, in this patient, the mass represented a squamous cell carcinoma. The surface is more granular in appearance, although this is not always the case.
A view of a whole mount of a tissue section taken from an epulis fissuratum shows that it is essentially a fibrous hyperplasia. The central groove can be observed, and, in this patient, papillary hyperplasia is present in some areas.
 
 
 
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