What are the other Names for this Condition? (Also known as/Synonyms)

• Congenital Gingival Cell Tumor
• Granular Cell Fibroblastoma
• Neumann's Tumor

What is Congenital Epulis? (Definition/Background Information)

• Congenital Epulis is a highly uncommon benign tumor that arises from the mucosal layers of the gums (in the mouth) of newborn children, typically females. It is also known as Congenital Gingival Cell Tumor and Neumann's Tumor
• Even though it is normally a benign condition, large-sized tumors may present breathing and feeding difficulties. A simple surgical excision is curative, and Congenital Epulis is not known to recur following treatment. Small-sized tumors generally regress and recede before the baby is about 8 months old

Who gets Congenital Epulis? (Age and Sex Distribution)

• Congenital Epulis is generally observed at birth or shortly after birth
• Both males and females are affected. A very high incidence is observed among girl babies (girl-boy ratio is 8:1)
• Worldwide, there is no racial or ethnic preference observed; however, the condition is rare

What are the Risk Factors for Congenital Epulis? (Predisposing Factors)

• No documented risk factors have been reported for Congenital Epulis
• Many of the cases (over 88%) are observed in girl babies

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Congenital Epulis? (Etiology)

The cause of formation of Congenital Epulis is not well-understood. It may originate from the neural crest during embryological development.

• Congenital Epulis is not known to be associated with any congenital/genetic syndromes
• Researchers have documented certain genetic changes within the tumor. However, cases where these specific genetic mutations have been observed are rare

What are the Signs and Symptoms of Congenital Epulis?

The signs and symptoms of Congenital Epulis may include:

• Appearance of a single soft mass/nodule almost always above the front incisor teeth of the upper jaw (anterior alveolar ridge)
• The skin (mucosa) over the nodule may be brownish red and is usually intact
• The mass may appear to be “hanging” from the upper jaw gums. It is a slow-growing tumor
• The mass usually projects out of the mouth as its size can range from 5 to 20 mm. Rarely, it may grow to be about 90 mm in size
• Large tumors can cause feeding and breathing difficulties
• 1 in 10 infants may present multiple lesions

How is Congenital Epulis Diagnosed?

A diagnosis of Congenital Epulis may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Oral cavity examination
• Tissue biopsy: A oral tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

A differential diagnosis is important to exclude other conditions presenting similar signs and symptoms may be needed. These include:

• Brown tumors of hyperparathyroidism
• Giant cell granuloma of the upper or lower jaw
• Osteoblastic osteosarcoma

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Congenital Epulis?

The possible complications due to Congenital Epulis include:

• Emotional stress for the parents and caregivers
• Cosmetic concerns due to bulge above the lip
• Severe feeding and breathing difficulties from large-sized tumors
• Local recurrences of the benign mass following its removal is not observed

How is Congenital Epulis Treated?

The healthcare provider may recommend the following treatment measures for Congenital Epulis:

• The healthcare expert may undertake a wait and watch approach for small-sized tumors, as these are generally known to regress and disappear even in the absence of any treatment
• Large-sized tumors that interfere with breathing and feeding are removed through surgical procedures. This may include CO2 laser surgery

Regular follow up visits with the healthcare provider may be recommended for a certain period of time.

How can Congenital Epulis be Prevented?

• Presently, there are no preventative guidelines available for Congenital Epulis since the cause of the condition is unknown
• Undertaking periodic and regular visits to a dental professional may be considered

What is the Prognosis of Congenital Epulis? (Outcomes/Resolutions)

• In majority of the cases, Congenital Epulis would either stop to grow, or completely disappear without treatment. The prognosis is generally excellent in such cases
• Tumors that grow to large sizes may be surgically removed; following surgery, they are not known to recur or create issues with tooth eruption or jaw profile in the growing child

Additional and Relevant Useful Information for Congenital Epulis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/dental-health/