Reactive lesions

Oral Pathology

Group of fibrous connective tissue (CT) lesions that occur when over exuberant repair (granulation tissue and scar) follows injury

Types of localized fibrous overgrowths:

1. Fibromatous

  • Nodular fasciitis
  • Gingival fibromatosis

2. Neoplastic & tumor like lesions

  • Neurofibroma
  • Giant cell fibroma
  • Fibrous histiocytoma
  • Malignant fibrous histiocytoma
  • Fibrosarcoma

3. Hyperplastic lesions/ localized CT hyperplasia

  • Epulides – CT tissue hyperplasia arising from gingiva
    • Fibrous epulis/ focal fibrous hyperplasia
    • Peripheral giant cell granuloma/ giant cell epulis
    • Vascular epulis/ pyogenic granuloma
  • Fibroepithelial polyp – firm, painless pedunculated/ sessile polypoid swelling away from gingiva
  • Papillary hyperplasia of palate
  • Generalized gingival hyperplasia
  • Denture induced fibrous hyperplasia

Fibrous epulis/ focal fibrous hyperplasia

Clinical:

  • Pedunculated/sessile mass
  • Firm consistency
  • Similar colour to gingiva
  • Surface may be ulcerated

Histology:

  • Cellular fibroblastic granulation tissue + interlacing bundles of collagen fibers
  • Inflammatory infiltrate = mostly plasma cells
  • Hyperkeratotic epithelium
  • Calcification in 1/3 of cases

Management: Surgical excision + full mouth scaling

Picture

Peripheral giant cell granuloma/ giant cell epulis

Vascular epulis/ pyogenic granuloma

Fibroepithelial polyp

Etiology:

  • Local irritants eg. calculi
  • Overhanging margins
  • Restorations
  • Foreign bodies
  • Chronic biting
  • Margins of caries and sharp spicules of bone
  • Overextended borders of appliance

Clinical:

  • Pedunculated/ sessile growth
  • Small lesions, rarely > 1cm
  • No malignant potential
  • Recur only if chronic irritation persists

Picture

Generalized gingival hyperplasia

Picture

Denture induced fibrous hyperplasia

Etiology: Chronic trauma due to I’ll fitting denture

Site:

  • Vestibular mucosa
  • Mandible lingual sulcus

Clinical:

  • Painless folds of fibrous tissues surrounding edge of overextended denture

Histology:

  • Hyperplastic epithelium with drop rete pegs
  • Connective tissue core
  • Early (vascular), late (avascular)
  • Leaf like shape

Management:

  • Replace or reline denture
  • Surgical removal of lesion

Picture