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

• Denture Epulis
• Denture-Induced Granuloma
• Denture-Induced Inflammatory Fibrous Hyperplasia

What is Epulis Fissuratum? (Definition/Background Information)

• Epulis Fissuratum is an oral cavity condition that is characterized by fibrous tissue overgrowth around poorly-fitting dentures due to chronic irritation between the inner cheek and edges of the denture. The condition is also known as Denture-Induced Fibrous Hyperplasia
• It is typically a benign condition that does not cause any significant signs and symptoms besides mouth discomfort. A simple surgical excision, if necessary, may be sufficient to treat Epulis Fissuratum, along-with re-adjustment of the ill-fitting dentures

Who gets Epulis Fissuratum? (Age and Sex Distribution)

• Epulis Fissuratum is generally observed in individuals who wear dentures, but particularly in elderly adults
• Both males and females are affected, but for some reason more women than men are affected (65-75% of the cases are reported in women)
• Worldwide, there is no racial or ethnic preference observed

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

• Use of ill-fitting dentures that irritate or injure the oral mucosa is the single-most important risk factor for Epulis Fissuratum
• Wearing dentures continuously for long periods, even while sleeping in the night
• Use of other dental implants may also potentially cause Epulis Fissuratum, although the condition is most commonly associated with dentures

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 Epulis Fissuratum? (Etiology)

• Epulis Fissuratum is a benign tumor-like overgrowth of tissue in the inner cheek, at the site of chronic irritation caused by the edges (flanges) of a poorly-fitting denture
• The overgrowth is termed hyperplasia, meaning an increase in size due to proliferation of cells. Due to the constant rubbing and brushing of the edges of the denture against the mucosal surfaces of the cheeks, it causes a hyperplastic response

What are the Signs and Symptoms of Epulis Fissuratum?

The signs and symptoms of Epulis Fissuratum may include:

• Presence of firm tumor-like lesions on the inner cheeks, around the sides of the dentures
• The benign overgrowth is usually pink-red and painless
• The lesion may grow in size to displace the denture or form below the denture too
• A groove may form in the lesion at the site where the denture flange pushes into it
• In severe cases, the lesion may ulcerate and bleed
• Large-sized tumors may cause eating difficulties and oral discomfort

How is Epulis Fissuratum Diagnosed?

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

• Physical examination of the individual and medical history evaluation, including history of denture use
• Oral cavity examination
• Skin biopsy, if needed: A skin 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, such as pyogenic granuloma, which presents similar signs and symptoms.

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 Epulis Fissuratum?

The possible complications due to Epulis Fissuratum include:

• Emotional stress
• Superimposed bacterial and fungal skin infections
• Eating difficulties from ill-fitting dentures and large-sized tumor
• Recurrence of the condition

How is Epulis Fissuratum Treated?

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

• Minor surgical procedure to remove the overgrowth
• Laser excision to remove the tumor
• Recalibrating the old denture and abrading rough edges to fit well, or using a new set of dentures
• Antibiotic or antifungal therapy for secondary infections, if necessary

Regular follow up visits with the healthcare provider is important and recommended.

How can Epulis Fissuratum be Prevented?

Epulis Fissuratum may be prevented by considering the following steps:

• Good denture care and maintenance:
  • Bring ill-fitting dentures and/or rough-edged dentures to the dentist’s attention immediately
  • Use dentures sparingly (only when required) and avoid wearing them continuously
  • Do not wear dentures while sleeping or during the entire night
• Proper denture hygiene: Washing and cleaning dentures as recommended, including disinfecting the same
• Undertake visits to a dental professional regularly, especially if dentures are being used

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

• The prognosis of Epulis Fissuratum is generally good with early recognition and appropriate treatment of the condition
• However, if the condition is left untreated and/or the reason for fibrous overgrowth in the mouth is unattended to, Epulis Fissuratum may persist for a long duration

Additional and Relevant Useful Information for Epulis Fissuratum:

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

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