1. Dr. Shahzadi Tayyaba Hashmi Soft tissue swellings of oral mucosa

2. INTRODUCTION Swellings may occur anywhere on the oral mucosa and relatively common in the oral cavity Majority are benign, reactive or inflammatory lesions, that is they form in response to some injury A few are benign neoplasms or developmental lesions and only very rarely are swellings malignant neoplasms Swellings may arise from the mucosa, the overlying epithelium or the underlying connective tissue They may relate to teeth, bone or salivary glands Swellings may occur anywhere on the oral mucosa and relatively common in the oral cavity Majority are benign, reactive or inflammatory lesions, that is they form in response to some injury A few are benign neoplasms or developmental lesions and only very rarely are swellings malignant neoplasms Swellings may arise from the mucosa, the overlying epithelium or the underlying connective tissue They may relate to teeth, bone or salivary glands

3. Swellings on the gingiva A swelling on the gingiva is called an epulis Most common types are: 1. Fibrous hyperplasia 2. Pyogenic granuloma 3. Giant cell granuloma A swelling on the gingiva is called an epulis Most common types are: 1. Fibrous hyperplasia 2. Pyogenic granuloma 3. Giant cell granuloma

4. 1) Fibrous hyperplasia These swellings are caused by overgrowth of fibrous connective tissue in response to chronic trauma Etiology: Plaque or calculus Orthodontic appliances Over- extended or ill-fitting Dentures Malocclusion Clinical features: Fibrous hyperplasia are covered by oral epithelium and appear pale and the same colour as surrounding mucosa Treatment: Remove the cause of trauma (e.g improve the fit of the dentures) Surgical excision These swellings are caused by overgrowth of fibrous connective tissue in response to chronic trauma Etiology: Plaque or calculus Orthodontic appliances Over- extended or ill-fitting Dentures Malocclusion Clinical features: Fibrous hyperplasia are covered by oral epithelium and appear pale and the same colour as surrounding mucosa Treatment: Remove the cause of trauma (e.g improve the fit of the dentures) Surgical excision

5. 2) Pyogenic granuloma Etiology: Trauma Overgrowth of immature, vascular connective tissue ( granulation tissue) Pregnancy Calculus and plaque Clinical features: Ulceration Clinically appears as red-blue or red lesion and may bleed easily Pyogenic granuloma often form in response to plaque and calculus Common in pregnancy and during puberty when there is an exaggerated vascular response due to hormonal changes. They are sometimes referred as pregnancy epulis Etiology: Trauma Overgrowth of immature, vascular connective tissue ( granulation tissue) Pregnancy Calculus and plaque Clinical features: Ulceration Clinically appears as red-blue or red lesion and may bleed easily Pyogenic granuloma often form in response to plaque and calculus Common in pregnancy and during puberty when there is an exaggerated vascular response due to hormonal changes. They are sometimes referred as pregnancy epulis

6. Treatment Remove the cause Improve oral hygiene In pregnant patients, it must be delayed until after the baby is born Remove the cause Improve oral hygiene In pregnant patients, it must be delayed until after the baby is born

7. 3) Giant cell granuloma Etiology: unknown Sites: Giant cell granuloma occur exclusively on the gingiva, usually in the anterior parts of the mouth They may become large and extend over the labial aspect of the teeth Clinical features: They are red-blue in colour Clinically difficult to distinguish from Pyogenic granuloma Treatment: Excision Etiology: unknown Sites: Giant cell granuloma occur exclusively on the gingiva, usually in the anterior parts of the mouth They may become large and extend over the labial aspect of the teeth Clinical features: They are red-blue in colour Clinically difficult to distinguish from Pyogenic granuloma Treatment: Excision

8. Swellings in other oral sites 1. Hemangioma 2. Lipoma 1. Hemangioma 2. Lipoma

9. 1)Hemangioma Key Features: Hemangiomas are developmental malformations of blood vessels, which are increased in number and show abnormal arrangement Hemangiomas appear red or blue-red clinically May extend into the surrounding tissues Because of the increased number of blood vessels, trauma to a Hemangioma can result in excessive bleeding It is not advisable to do Surgical intervention in the region of Hemangioma Key Features: Hemangiomas are developmental malformations of blood vessels, which are increased in number and show abnormal arrangement Hemangiomas appear red or blue-red clinically May extend into the surrounding tissues Because of the increased number of blood vessels, trauma to a Hemangioma can result in excessive bleeding It is not advisable to do Surgical intervention in the region of Hemangioma

10. 2) Lipoma Key features: Benign tumours of fat Common on buccal mucosa They may appear yellow but are often mucosal colored Not associated with trauma Key features: Benign tumours of fat Common on buccal mucosa They may appear yellow but are often mucosal colored Not associated with trauma