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Epulis

Epulis

 

==Description==  

==Description==  

Peripheral odontogenic fibroma is a benign tumour that arises from the [[Periodontal ligament - Anatomy & Physiology|periodontal ligament]]. It was previously known as a fibromatous epulis and ossifying epulis depending on the degree of mineralization.  

Peripheral odontogenic fibroma is a benign tumour that arises from the [[Periodontal ligament - Anatomy & Physiology|periodontal ligament]]. It was previously known as a fibromatous epulis and ossifying epulis depending on the degree of mineralization.  

They present as firm, smooth swellings of the [[Oral Cavity - Teeth & Gingiva - Anatomy & Physiology|gingiva]] and are normally indistinguishable from [[Gingival Hyperplasia|gingival hyperplasia]].

They present as firm, smooth swellings of the [[Oral Cavity - Teeth & Gingiva - Anatomy & Physiology|gingiva]] and are normally indistinguishable from [[Gingival Hyperplasia|gingival hyperplasia]].

Not to be confused with [[Acanthomatous Ameloblastoma|Acanthomatous Ameloblastoma]].

 

Most common benign tumour found in the oral cavity in dogs but is less common in cats. Is seen in dogs of any age but more common in those older than 6 years.

==Diagnosis==

==Diagnosis==

===Clinical Signs===

===Clinical Signs===

*halitosis

Include halitosis, oral bleeding, dental disruption or loss, facial or mandibular deformity, excessive salivation, growth protruding from the mouth and rarely dysphagia.

*oral bleeding

*dental disruption or loss

*facial or mandibular deformity

*excessive salivation

*growth protruding from the mouth

*dysphagia occurs rarely

===Diagnostic Imaging===

===Diagnostic Imaging===

Radiographs are required to differentiate this benign neoplasm from malignant or locally aggressive lesions. Skull radiographs will evaluate the oral lesion itself and thoracic radiography to evaluate for metastasies (if a malignancy is a diagnostic possibility). Radiographs typically show a soft tissue opacity in the the [[Oral Cavity - Teeth & Gingiva - Anatomy & Physiology|gingiva]] region with varying degrees of mineralization. Bone involvement is '''not''' a feature of this neoplasm.

Radiographs are required to differentiate this benign neoplasm from malignant or locally aggressive lesions. Skull radiographs will evaluate the oral lesion itself and thoracic radiography to evaluate for metastasies (if a malignancy is a diagnostic possibility). Radiographs typically show a soft tissue opacity in the the [[Oral Cavity - Teeth & Gingiva - Anatomy & Physiology|gingiva]] region with varying degrees of mineralization. Bone involvement is not a feature of this neoplasm and hence is not to be confused with [[Acanthomatous Ameloblastoma|Acanthomatous Ameloblastoma]] which often invades bone.

Radiography cannot be used to differentiate a peripheral odontogenic fibroma from a [[Gingival Hyperplasia|hyperplastic gingival lesion]].

Radiography cannot be used to differentiate a peripheral odontogenic fibroma from a [[Gingival Hyperplasia|hyperplastic gingival lesion]].

===Biopsy===

===Biopsy===

An incisional biopsy is required to obtain a definitive diagnosis

An incisional biopsy is required to obtain a definitive diagnosis.

 

 

==Treatment==

==Treatment==

An excision of the neoplasm should be performed. The depth of the excision is determined by the location of the origin of the neoplasm at the [[Periodontal ligament - Anatomy & Physiology|periodontal ligament]].

An excision of the neoplasm should be performed. The depth of the excision is determined by the location of the origin of the neoplasm at the [[Periodontal ligament - Anatomy & Physiology|periodontal ligament]].

Excision may be at the gingival level or a deep resection involving the extraction of the affected tooth and curettage of the alveolar socket.  

Excision may be at the gingival level or a deep resection involving the extraction of the affected tooth and curettage of the alveolar socket.  

==Prognosis==

==Prognosis==

Good following surgical resection. Recurrence is common following incomplete surgical resection.

Good following surgical resection. Recurrence is common following incomplete surgical resection.

==References==

==References==

*Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''

Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''

*Merck & Co (2008) '''The Merck Veterinary Manual'''

Merck & Co (2008) '''The Merck Veterinary Manual'''

==From Pathology==

==From Pathology==

*The stroma contains neoplastic fibroblasts, with varying cellularity.  

*The stroma contains neoplastic fibroblasts, with varying cellularity.  

*The overlying epitheluim is normal.

*The overlying epitheluim is normal.

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With thanks to Andrew Jefferies (Cambridge) and Alun Williams (RVC) for providing access to their lecture materials

With thanks to Andrew Jefferies (Cambridge) and Alun Williams (RVC) for providing access to their lecture materials