epulis

An epulis is a type of benign (non-cancerous) mass-like growth that occurs in the mouth, typically on or around a tooth. It can appear as an enlargement on the gum tissue near incisors, canines, or molars [8]. Epulides are classified into three types: fibromatous, ossifying, and acanthomatous.

The description of epulis varies depending on its type:

• Fibromatous epulis appears on a stalk of tissue, much like a mushroom, or as an unmoving mass. It is usually pink in color and has a non-ulcerated smooth surface [3].
• Epulis fissuratum is a mucosal hyperplasia that results from chronic low-grade trauma induced by a denture flange [7].
• Congenital epulis is a rare tumour of the newborn that arises from the mucosa of the gingiva.
• Giant-cell epulis is a peripheral giant cell granuloma that arises exclusively from the periodontal ligament enclosing the root of a tooth.

Epulis can be asymptomatic, exophytic, smooth-surfaced or focally ulcerated, mucosal-colored mass with a variable growth rate [5]. It may appear as an enlargement on the gum tissue near incisors, canines, or molars.

Common Signs and Symptoms of Epulis

Epulis, a non-specific term for tumors and tumor-like masses on the gingiva (gums), can exhibit various signs and symptoms in dogs. Here are some common ones:

• Visible lump: The most noticeable sign is a raised, red mass on the gums.
• Oral bleeding: Some dogs may experience bleeding in their mouth due to the growth of epulis.
• Difficulty eating and discomfort when chewing: As the tumor grows, it can cause pain and discomfort while eating or chewing food.
• Drooling: Excessive drooling is another symptom associated with epulis.
• Halitosis: Bad breath (halitosis) can also be a sign of epulis in dogs.

Additional Symptoms

In some cases, epulis can lead to more severe symptoms, including:

• Facial deformity: The growth of the tumor can cause facial deformities or asymmetry.
• Pain and discomfort: Dogs with epulis may experience pain and discomfort due to the rapid growth of the tumor.

Important Note

It's essential to seek veterinary attention if you suspect your dog has epulis. Early detection and treatment can help prevent further complications and ensure a better quality of life for your pet.

References:

• [1] Signs include a lump on the gums, drooling, halitosis, facial deformity, and other signs of mouth injury. The visible lump is the most common ...
• [3] Mar 13, 2023 — Symptoms of Epulis in Dogs​​ Most pet owners first notice epulis as a raised, red mass on their dog's gums.
• [4] Apr 9, 2023 — Common clinical signs of epulis in dogs include: Oral bleeding in the dog's mouth. Difficulty eating and discomfort when chewing.
• [5] Gum-colored and perhaps a bit knobbly in appearance, this kind of tumor has a way of insinuating itself between the teeth as it expands.
• [9] Jul 29, 2024 — Signs include a lump on the gums, drooling, halitosis, facial deformity, and other signs of mouth injury. The visible lump is the most common ...

Diagnostic Tests for Epulis

Epulis, a type of oral tumor, can be diagnosed through various tests and examinations. Here are some of the diagnostic tests used to identify epulis:

• Visual Examination: A visual examination of the mouth is the first step in diagnosing epulis. Your veterinarian or dentist will examine your dog's mouth as part of their complete physical exam [5].
• Radiographs (X-rays): Radiographs of the head can determine how invasive the tumor is and help identify its location [3].
• Computed Tomography (CT scan): A CT scan of the jaw and skull may be recommended to further evaluate the extent of the tumor [4].
• Biopsy: A biopsy, which involves collecting cells from the tumor for examination under a microscope, is necessary to fully distinguish an epulis from other oral tumors [8][10]. Conservative excisional biopsy is indicated because both lesions are rarely larger than 2 cm in diameter [10].

It's essential to note that no clinical laboratory tests are used for these lesions, and a definitive diagnosis requires a biopsy [10].

References:

• [3] Nov 11, 2013 - Diagnosis begins with a visual examination of the mouth. Radiographs of the head can determine how invasive the tumor is.
• [4] by CG Ruaux · 2011 — Your veterinarian may recommend x-rays or computed tomography (CT scan) of the jaw and skull, collect- ing cells from the tumor for examination under the ...
• [5] Oct 20, 2021 — How Vets Diagnose Epulis in Dogs. Your veterinarian will examine your dog's mouth as part of their complete physical exam.
• [8] Sep 26, 2024 — An epulis may be suspected by its location and appearance during a physical exam, though a biopsy is necessary to fully distinguish an epulis ...
• [10] Epulis diagnosis. No clinical laboratory tests are used for these lesions. A definitive diagnosis requires biopsy. Conservative excisional biopsy is indicated because both lesions are rarely larger than 2 cm in diameter.

The differential diagnosis of epulis, a localized gingival enlargement, includes several conditions that can present similarly to epulis in terms of clinical appearance and symptoms.

Possible Differential Diagnoses:

• Pyogenic granuloma (Lobular Capillary Hemangioma) [1]
• Peripheral giant cell granuloma [2], [5]
• Fibroma [3], [8]
• Peripheral odontogenic fibroma [8]
• Fibrosarcoma [3]
• Squamous cell carcinoma [4]

Other Conditions to Consider:

• Epulis fissuratum, a mucosal hyperplasia caused by chronic low-grade trauma from dentures [2]
• Collagenous fibroma (desmoplastic fibroblastoma) [11], [12], [13]
• Gingival epulis, an enigma for clinical diagnosis [12]

Key Points to Consider:

• The differential diagnosis of epulis can be challenging due to its varied presentation and histological structure.
• A biopsy is often necessary to establish a definitive diagnosis.
• Immunohistochemical markers may be used to differentiate between fibroproliferative lesions, such as peripheral odontogenic fibroma (POF) and fibrous epulis (FE) [15].

References:

[1] The differential diagnosis includes pyogenic granuloma, peripheral giant cell granuloma, fibroma, peripheral odontogenic fibroma, fibrosarcoma, and squamous cell carcinoma. 1,3,5 [2] Epulis fissuratum is a mucosal hyperplasia that results from chronic low-grade trauma induced by a denture flange. [3] Various tumorlike reactions of the oral mucous membranes under the term Epulis are summarized. [4] Hyperparathyroidism should be considered in differential diagnosis in case of multiple lesions especially with a history of recurrences. [5] The localized epulis like lesions can also be classified as being benign or malignant. [8] The localized epulis like lesions can also be classified as being benign or malignant. Benign masses could be, fibroma, peripheral giant cell granuloma, central ... [11] This evidence is the most reliable condition to make the differential diagnosis. [12] Gingival Epulis, An Enigma for Clinical Diagnosis: A Case Report Sudhir Varma1,Salim Abufanas2,Vijay Desai3,Maher Shayeb4 [13] The term epulis is a topographico-clinical concept saying nothing about the histological structure or pathogenesis of the lesion. [15] Although its histological differential diagnosis from fibrous epulis (FE) is important, no study has reported the differences in their expression of immunohistochemical markers.