INFLAMATORY

OVERGROWTHS

Dr. Shahzad Hussain

BDS, FCPS(r)
OMFS, NID Multan
MUCOCELE
 A mucocele is a benign, mucus-containing
cystic lesion of the minor salivary gland. This
type of lesion is most commonly referred to
as mucocele
 TORUS PALATINUS
  bony protrusion on the palate. Palatal tori are
usually present on the midline of the hard palate.
Most palatal tori are less than 2 cm in diameter,
but their size can change throughout life.
DENTAL ABSCESS
 A dental abscess is a collection of pus that can form inside
the teeth, in the gums, or in the bone that holds the teeth
in place. It's caused by a bacterial infection. An abscess at
the end of a tooth is called a periapical abscess.
An abscess in the gum is called a periodontal abscess.
CELLULITIS
 Cellulitis is a common, potentially serious
bacterial skin infection. Cellulitis appears as
a swollen, red area of skin that feels hot,firm
and tender. It can spread rapidly to other
parts of the body
ABSCESS
 An abscess is a collection of pus that has built up
within the tissue of the body. Signs and
symptoms ofabscesses include redness, pain,
warmth, and swelling. The swelling may feel
fluid-filled when pressed.
OVERVIEW
 All inflatamatory growths of the oral cavity
must be treated wiith suspicion and fully
investigated….!!!
 There are some of these which have a clear
cut presentation but appearances can be
misleading!!!
EPULIS
 Defined as soft tissue swelling of the gingival
margin
 Hyperplastic
 Inflamatory lesions
 arising from periodontal tissues
 The lesion arises from interdental tissues, source
of irritation is not always known.
 Often there is loss of interdental bone which
becomes severe with the increase in the severity
of the lesion.
 More common in females than in males
 From anterior teeth to molar
VASCULAR EPULIS
 Pyogenic granuloma
 Pregnancy epulis
 The lesion remains vascular and immature & is not
fibroses, so that’s why it is much redder than fibrous
type and has a tendency to bleed easily because of its
high vascular content
 Pregnancy epulis is same as pyogenic granuloma , except
that it occurs in pregnancy
FIBROUS EPULIS

 Pedunculated or sessile
 Heavily fibrosed Granulation tissues depending
on the maturity level of the lesion
 Firm rubbery consistency
 Pale pink color
 Long standing lesion make get
 focal mineralization or
 bone formation
GIANT CELL EPULIS

 The Granulation is Osteogenic in nature

 Multinucleated giant cells dispersed in a
vascular stroma
 In its immature form, the lesion is
characteristically red-purple in colour
MANAGEMENT
 Local Excision
 Incomplete removal may cause recurrence
 Repeated recurrence may have to be treated with
the extraction of the adjacent teeth to secure the
elimination of the adjacent teeth to secure the tissue
of the origin
 Histopathological examination should always be done
to rule out any malignancy
 Central Giant cell granuloma may perforate the
alveolar bone and resemble clinically as peripheral
giant cell granuloma (epulis)
 Appropriate investigations must be done to rule out
hyperparathyroidism
FIBROEPITHELIAL POLYP
 Structurally similar to mature fibrous epulis
 Result of scar formation, due to repeated
irriation of buccal or labial mucosa from sharp
edges of the teeth or cheek biting.
 No sex prediction
 Sessile or pedunculated
 Free of symptoms
 Equal in gender tendency
 Usually 1 cm in size
 Recurrence is uncommon
 Pink in color with soft to firm consistency
MANAGEMENT
 Local excision
 Histopathological examination is required for
exact diagnosis although mostly its clinically
diagnosed
 Recurrence is uncommon and only if the
source of irritation is repeatedly present
 Leaf Fibroma
DENTURE GRANULOMA
 inflammatory fibrous hyperplasia, denture-
induced fibrous inflammatory hyperplasia,
denture injury tumor, denture epulis, denture
induced granuloma, and granuloma fissuratum
 Benign lesion, Similar to fibroepithelial polyp
 Except that the source of irritation in this case
is a flange of an overextended or ill fitting
denture
 Typical fissured shape of the lesion
 Rarely painful or causing any trouble to the
patient
MANAGEMENT

???
FOCAL EPITHELIAL
HYPERPLASIA
  is a specific human papillomavirus (HPV)
infection in the mouth. It is also known as
Heck’s disease.
 Children from black african, eskkimo and
american indian groups
 Multiple raised, pink and soft, sessile lesions
on labial and buccal mucosa
 Painless
 Normal epithelium with hyperplasia with
marked cellular irregularities
 Genetic basis is also involved
DEVELOPMENTAL LESIONS
(GROWTHS)
 Hemartomas
 Developmental White Lesions
HEMARTOMA
 Is a localized, non progressive tissue
abnormality resulting from a defect of
development.
 Neither inflamatory nor neoplastic
 Nevus (when on skin)
ANGIOMATOUS NAEVAE
 Developmental
 Either lymphatic or vascular component of
mucosa
 Common in the oral cavity having Strawberry
mark of skin
 May be capillary, venous or cavourness
(mistaken for melanoma)
 Asymptomatic and best left untreated.
 A hemangioma is a benign and usually self-involuting
tumor of the endothelial cells that line blood vessels,
and is characterised by increased number of normal
or abnormal vessels filled with blood.
 May be present at Birth or arise during early childhood.
 Mostly within Skin
 May be relatively large, covering large skin,
Which are termed as birthmarks.
 Mostly invoulate by the time of puberty.
 Those hemangiomas that do not invoulate are
called hemartomas.
CAPILLARY HEMANGIOMA
 occur in superficial layer of skin.
 most common type of hemangioma.
 made up of small capillaries that
are normal in size and diameter,
but high in number.
 Because of their proximity to the
surface of the skin, capillary
hemangiomas are typically brighter
red in color.
CAVERNOUS HEMANGIOMA
 In contrast with a capillary
hemangioma, a cavernous
hemangioma is made up of larger
blood vessels that are dilated.
 The blood vessels are not as
closely packed as in a capillary
hemangioma
 the spaces (or "caverns") between
them are filled with blood
INTRA MUSCULAR HEMANGIOMA

 Arise any where in the soft tissue of head &

neck
 Spongy Texture on palpation
 Usually deep seated
 Seen on the tongue and lips
CLINICAL FEATURES OF
HEMANGIOMA
 Usually raised
 Often Multinoduler
 No sex prediction
 Blenching on compression
 May Arise in any site but most commonly
arise in tongue
LYMPHANGIOMA
 Lymphangiomas are benign tumours of lymphatic
vessels
 shows as a focal superficial lesion in the oral
cavity and as a massive diffuse lesion of the neck
(cystic Hygroma)
 Involves lymph vessels
 Dilated lymphatic vessels and spaces in connective
tissue
 Much more common on the tongue
 Superficial lesions appear translucent
 Deep lesions appear greyish and nodular
 Entirely innocuous lesion
FEATURES
 Arise during childhood
 No sex prediction
 Two major types in the head & neck region
 1: Self limiting in the oral cavity
 2: Cystic hygroma in the lateral neck in
MANAGEMENT

????
WHITE LESIONS OF THE ORAL
CAVITY
 There are multiple changes in the normal oral
mucosa which can lead it to appear white like
1. Hyperkeratosis
2. Acanthosis
3. Accumulation of intracellular or extracellular
fluid in the epithelium(leukoedema)
4. Necrosis of oral epithelium
5. Microbes particularly fungi
6. Reduced vascularity in the underlying lamina
propria.
MEMORIZE IT FOREVER (THIS IS HOW
WHITE AND RED LESIONS OF THE
ORAL CAVITY ARE CLASSIFED)
DEVELOPMENTAL WHITE LESIONS
 Lesions appear as white patches in the oral
cavity
 Number of genetically determined lesions
 Characterized by disturbance of
keratinization and often classified as
genrdermatoses or genokeratoses
WHITE SPONGE NEVUS
 Oral epithelial naevus
 Affects oral mucosa only
 Also called white folded gingivostomatosis.
 Neither inflamatory nor neoplastic
 Folded white lesion of oral mucosa
 May involve whole oral cavity
 Autosomal dominant transmission
 No case of malignancy seen
 Acanthosis and parakeratois
 Pachyonychia congenita
 genetic autosomal dominant skin disorder
 Excess keratin in nail beds and thickening of the
nails
 Hyperkeratosis on hands and feet
 Oral lesions that look like thick white plaques
 Hereditary benign intraepithelial dyskeratosis
 Hereditary benign intraepithelial dyskeratosis is a
rare autosomal dominant disease of the conjunctiva
 and the oral mucosa caused by a duplication of 
chromosome 4q35.In the mouth it appears similar to 
white sponge nevus, with painless, diffuse, folded
and spongy white plaque
 Dyskeratosis Congenita

 abnormal skin pigmentation

 Nail dystrophy
 Mucosal leukoplakia occurs in approximately 80%
of patients and typically involves the buccal
mucosa, tongue, and oropharynx. The
leukoplakia may become verrucous, and
ulceration may occur. Patients also may have an
increased prevalence and severity of periodontal
disease.
TYLOSIS(PALMOPLANTAR
KERATODERMA)
  autosomal dominant syndrome
 oral precursor lesions particularly on the
gums (leukoplakia)
 risk of esophageal cancer (95% develop
esophageal cancer by the age of 65

 Hyperkeratosis of skin of palms and

soles(tylosis)
DARIER’S DISEASE
 Fllicular keratosis
 Young adults
 Greasybrown papules on the chest and
shoulder
 Pitting of skin of palms and hands and nails
 White lesion of buccal mucosa
NEOPLASMS
 a new and abnormal growth of tissue in a
part of the body
 Classified as
 Benign
 Carcinoma in Site(potentially malignant)
 Malignant
 Accurate Diagnosis depends upon???
 Squamous cell papiloma (Benign)
 Squamous cell carcinoma (malignant)
 Role of HPV??
SQUAMOUS CELL PAPILLOMA
 Benign
 Ephithelia neoplasm
 Most common bening neoplasm of oral cavity
 May appear anywhere in the oral cavity
 Junction of hard and soft palate
 Color varies from normal pinkish to white
 Painless
 No Malignant transformation
 Cauliflower like apperance and pedunculated
 Local excision (wide and deep)
VIRAL WARTS
 Clinically similar to papillomas
 Commonly on and around the lips
 Autoinoculation
 Clinical classified as those with no evident
infective etiology or through inoculation
TRAUMATIC KERATOSIS

 Also known as Reactive/inflammatory white

Lesions which include
 Frictional (Traumatic) keratosis
 Chemical injuries of the oral mucosa
 Actinic keratosis (cheilitis)
 Smokeless tobacco-induced keratosis
 Nicotine stomatitis
FRICTIONAL KERATOSIS
 Local reaction to earlier physical
mechanical,electrical or thermal causes
 Topical cause such as aspirin
 Chemical such as ingestion of caustic or acid
substance
 Smoking cigrette, cigars or pipes,
combination of chemical and thermal injury
FRICTIONAL KERATOSIS
 Important factor in white lesions
 Trauma has wide variety of effects
depending upon
 Nature of trauma
 Rate of application
 Severity
 Individual’s body response
 When the trauma is acute, epithelium is
destroyed and ulcer is produced
 When It is less acute and localized, response
depends upon exact situation
 If the irritation in chronic and low intensity,
major change is in the keratinization
abnormality which is reversible
 Mucosal most common response is to denture
granuloma in which change lies in the
connective tissue component
NICOTINIC STOMATITIS
 Combination of epithelial hyperkeratosis and
acanthosis with inflamatory changes in the
mucous glands of the palate
 White palate with protruding nodules with
each representing a gland and center of
which is red representing the opening of the
gland
 Advane cases may result in large scar
 Mostly on hard palate
 Management ???
LEUKOEDEMA
 Leukoedema is a common mucosal
alteration that represents a variation of the
normal condition rather than a true pathologic change
 Faint, white, diffuse, and filmy appearance
 Numerous surface folds resulting in wrinkling

of the mucosa.
 It cannot be scraped off
 It disappears or fades upon stretching

the mucosa.
 Microscopic examination reveals thickening

of the epithelium, with significant intracellular

edema of the stratum spinosum. The
surface of the epithelium may demonstrate a
thickened layer of parakeratin.
TREATMENT
 No treatment is indicated, no malignant
change has been reported.
THANK YOU