p e d i a t r i c d e n t a l j o u r n a l 2 6 ( 2 0 1 6 ) 4 2 e4 4

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Pediatric Dental Journal

journal homepage: www.elsevier.com/locate/pdj

Case Report

Epulis fibrosa identified in a 6-year-old Japanese

girl

Masakazu Hamada a,*, Ayako Takasu a, Ryota Nomura b, Rena Okawa b,

Kazuhiko Nakano b, Yoshiaki Yura a
a
Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
b
Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan

article info abstract

Article history: Epulis is a relatively common benign polypoid lesion that generally appears in the gingiva
Received 16 November 2015 of individuals aged between 20 and 50 years. A 6-year-old Japanese girl came to our hos-
Received in revised form pital for consultation regarding swelling of the marginal gingiva in the region between the
5 January 2016 maxillary left deciduous lateral incisor and canine. An intraoral examination revealed that
Accepted 8 January 2016 the surface of the swollen mass was nonulcerated and smooth, and its color was similar to
Available online 15 March 2016 that of the surrounding gingival tissue. X-ray findings showed no calcified body or tooth
germ malposition. The lesion was removed surgically under local anesthesia and histo-
Keywords: pathological findings showed it to be composed of fibrous connective tissue and blood
Epulis vessels with minimal inflammatory cells, and covered by stratified squamous epithelium
Child cells under the mucosa, which led to a diagnosis of epulis fibrosa. Patient prognosis has
Non-neoplastic lesion been good to date with no symptoms indicating recurrence.
Pathological diagnosis Copyright © 2016 The Japanese Society of Pediatric Dentistry. Published by Elsevier Ltd. All
rights reserved.

stimuli, including trauma and others [2e4]. Here, we report an

1. Introduction epulis fibrosa identified in 6-year-old girl.

Epulis is a compound word formed by epi and oulon, which mean

up and gingiva, respectively, in Greek. Clinically, it is used to
describe a benign localized mass appearing in the gingiva [1]. An
epulis is commonly found in adults aged between 20 and 50
years with several subtypes, including epulis osteoplastica,
epulis fibromatosa, epulis fibrosa, epulis granulomatosa, epulis
hemangiomatosa, giant cell epulis, and congenital epulis, and is
thought to be a reactive proliferation of the gingiva by various
2. Case report
A 6-year-old girl was referred to the Department of Oral and
Maxillofacial Surgery at Osaka University Dental Hospital with
the chief complaint of gingival swelling in the region of the
maxillary left deciduous lateral incisor and canine, which was
originally noticed by the patient and her parents 1 month prior.

* Corresponding author. Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka,
Suita, Osaka, 565-0871, Japan.
E-mail address: hmdmskz@dent.osaka-u.ac.jp (M. Hamada).
http://dx.doi.org/10.1016/j.pdj.2016.01.001
0917-2394/Copyright © 2016 The Japanese Society of Pediatric Dentistry. Published by Elsevier Ltd. All rights reserved.
 p e d i a t r i c d e n t a l j o u r n a l 2 6 ( 2 0 1 6 ) 4 2 e4 4 43

Fig. 1 e Intraoral photograph taken at the initial visit.

Arrow shows the area of swelling of the gingiva.

They did not note any changes in the lesion before coming to
our clinic. Intraoral examinations revealed that the surface of
the lesion appeared to be nonulcerated and smooth, with a color
(in the web version) similar to that of the surrounding gingival
tissue (Fig. 1). Tooth mobility of the teeth in the region was not
observed. An orthopantomograph examination showed no
abnormal findings, and no evidence of a calcified body or mal- Fig. 3 e Histopathological appearance of the excised lesion.
positioned tooth germ was revealed in a periapical radiograph The square area in panel A is magnified in panel B.
examination (Fig. 2). By contrast, dental X-ray findings showed
caries in the frontal teeth and alveolar bone resorption (Fig. 2B).
inflammatory hyperplasia (19.2%), and epulis (9.0%) [5].
Since the lesion was suspected to be epulis, we proposed an
Although epulis is commonly identified in adults, it is known
excisional biopsy, which was agreed to by the patient's parents.
to develop in all ages, including childhood and even newborns
Under local anesthesia, the lesion was removed surgically from
[6,7]. Previous analyses of 15 pediatric patients with epulis
under the mucosa and histopathological analysis was per-
revealed that approximately 70% were aged 9 years and older,
formed, which demonstrated that it was composed of fibrous
while all of the remaining patients, except for one with
connective tissue and blood vessels with minimal inflamma-
congenital epulis, were aged 3 years or younger [6]. It is
tory cells, and covered by stratified squamous epithelium cells,
reasonable to speculate that poor oral hygiene conditions
leading to a diagnosis of epulis fibrosa (Fig. 3). At the time of
during the mixed dentition stage appearing at approximately
writing, the course of the patient has been good, with no
9 years of age as well as the primary tooth eruption stage from
symptoms indicating recurrence observed (Fig. 4).
newborn to approximately 3 years of age triggers development
of epulis. However, it is quite uncommon to encounter a pa-
tient with epulis at the stage of completion of eruption of
3. Discussion primary teeth, as seen in the present case. Although it is
difficult to determine the reason for its development in our
A previously reported analysis of non-neoplastic lesions patient, it is important for practitioners to keep in mind that
showed that pyogenic granuloma was the most frequent epulis can develop in children aged 3e9 years, although the
(38.5%), followed in order by fibrous hyperplasia (20.5%), incidence is extremely low.

Fig. 2 e X-ray examinations at the initial visit. (A) Orthopantomograph. (B) Periapical radiograph.
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