Case presentation on EPULIS

Case presentation of a female with recurrent fibrous epulis

1. Presented by- Dr. Ha-Meem Fattaha IS Batch – 26 Sapporo Dental College & Hospital PRESENTATION ON EPULIS Department of Oral Pathology & Periodontology

2. What is epulis?: Epulis a generic term used clinically to describe tumor and tumor like mass of the gingiva. The term refers only to the site of the lesion, but it does not describe it. Most lesions referred to as ‘epulis’ are inflammatory rather than neoplastic.

3. Particular’s of the patient: Name: Rina Age: 35 years Sex: Female Reg. No: 76422/15 Occupation: Maid servant Marital status: Unmarried Address: Sector- 10, Uttara , Dhaka . Date: 12.02.15

4. Chief complain: Large painless swelling present in the anterior segment of upper jaw for last 4 months. History of present illness: According to the patients statement she was alright 4 months back. Then she developed a painless swelling in the anterior segment of upper jaw. The swelling increased in size gradually. Bleeding occurs from the surrounding gum during brushing.

5. Medical history: Anemia: Present Jaundice: Absent Blood pressure: 110/ 70 mm of Hg Diabetes mellitus: Absent Bleeding disorder: Absent Rheumatic fever: Absent Others: Absent Past dental history: Surgical excision of epulis 2 times.

6. Maintenance of oral hygiene : She maintains her oral hygiene by brushing her teeth once before breakfast with brush and paste. Personal & social history: She belongs to a low socio-economic family. Her parents passed away and they had no history of significant disease. She is not habituated with betel quid or tobacco.

7. Examination: General Examination: Anemia present. Systemic Examination: Nothing abnormal detected. Local Examination : EXTRA ORAL: Regional Lymph node: Not palpable Temporo-mandibular joint: Normal Salivary gland: Not palpable Lip: Incompetent Others: Nothing abnormal detected.

8. INTRA ORAL: Swelling: Swelling present in palatal mucosa in relation to the mesial surface of upper left central incisor. Oral mucosa: Pale pink in color

9. Gingiva : Gingival swelling present in some areas and gingival recession present.

10. Before scaling:

11. After scaling:

12. Investigations : Blood for- CBC, HbsAg , AntiHCV Periapical radiograph ( Previously done) Fig: Periapical radiography exhibiting no osseous or dental involvement

13. Provisional diagnosis: Recurrent fibrous epulis. Clinical diagnosis: Recurrent fibrous epulis on upper anterior region in relation to upper left central incisor. Treatment: Surgical excision and deep curettage of epulis with surrounding normal tissue.

14. Operative procedure: (23.02.15) Under all aseptic precaution local anaesthesia was given. After confirmation of the anaesthesia the lesion was excised with electric knife without removing the tooth.

15. The underlying bone was curetted and cauterization was done. After removal thorough irrig - - ation was done with 10% povidi - -ne iodine and perio pack was given. Advised for biopsy.

16. Medications: Cap.Cefixime 200 mg(cap.Cef-3 200 mg) 1+0+1x12 hourly for 7 days. Tab.ketorolac 10 mg( Tab.Torax 10 mg) 1+0+1x12 hourly if pain after meal. Cap.Omeprazole20 mg( Cap.Seclo 20 mg) 1+0+1xHalf an hour before meal. Tab . Vitamin C 1000mg( Tab.Cevit forte) 1+0+1xmixing with half glass of water for 20 days .

17. Medications: Ferrous Sulphate ( Cap.Zif ) 1+0+1 for 30 days. Cap.Tranexamic Acid 500 mg( Cap.Frabex 500 mg) 1+0+1 for 3 days. Mouth wash- Viodin 1% Diluted with ewual amount of warm water and rinse 3-4 times Per day for 15 days.

18. 1 st Follow up- After 7 days (02.03.15):

19. 2 nd Follow up- After 21 days ( 16.03.15):

20. References: CAWSON’s essentials of oral pathology and oral medicine 8 th edition. CARRANZA’S clinical periodontology 10 th edition.