CASE REPORT

Epulis Granulomatosa Case

Report
OPERATOR: DRG. CUT MYTHA FITRIANA
SUPERVISOR: DRG. ANANDINA IRMAGITA, SP.PM

BY DANNY TANDEAN (1306366350)

Patient’s Status

Age/D.O.B:
Name: NM Sex: Male
36/01-05-1981

NRM: 01-09-15-98 Date: 02-06-2017

Case Report
2ND JUNE 2017
Anamnesis
Patient came with a complaint of lump in upper right gingiva.

Consume oral Was referred from RS Citra Symptomatic when consuming hard
antibiotic, but Medika in Depok, given no texture foods and during the cold
nothing change medication weather

No smoking habit, no Last visit to dentist 5 months ago fot

Chewing on one systemic disease, no scaling, brush teeth once a day
side (left) chancre history in family, (morning), consume instand noodle
married twice a week
Intra Oral
Gingiva region 12: shallow, white
Extra Oral
base, round, defined border,
Right buccal mucosa:
multiple ulser on region 48
pedunculated, 2 mm in diameter KGB:
lesions and surrounded by
erythematous halo TAK
Dry Lips
Gingiva region 16: nodule 3x4x3 cm
in volume, irregular, darker red colour 2/3 posterior dorsum of
than surrounding, soft consistency, tongue: mild white coating
sessile Dental:
36, 46: Missing
37: Dentin Caries
Poor oral hygiene: stain, debri, sub and supra gingival 35: Cusp tip fracture
calculus 18, 28, 38: Impacted
Diagnosis
Suspected Epulis Granulomatosa

Gingivitis

Pulp Hyperemia #37

Missing teeth #36 #46

Impact tooth #18 #28 #38

 Treatment
Susp. Epulis Eliminate focus Restore chewing
CIE
Granulomatosa infection function
• Brush teeth 2x a day • Pro Incisional • Pro scaling • Pro denture
• Gargle CHx 0,2% biopsy (refer to • Pro tooth restoration
2x a day periodontology) #37
• Pro patology
anatomy
Literature Review
Peripheral Giant Cell Granuloma / Epulis
Gigantocellularis
Benign, generally asymptomatic inflammatory hyperplastic lesion in which cells with fibroblastic,
osteoblastic, and osteoclastic potential predominate

Usually found on the gingiva margin between teeth anterior to the permanent molars, sessile or
pedunculated lesion

Etiology: Permanent Irritation or Trauma

Initially, mucosa shows unchanged color and looks thickened  grows to an impressive mass, red and
dark red in color and soft consistency that can destroy bone
Peripheral Giant Cell Granuloma / Epulis
Gigantocellularis

Ulcerations may occur secondary to trauma

The size usually does not exceed 5 cm in diameter, but can be bigger

Its base is narrower than its entire volume

Early stage of development  X-ray doesn’t show any change, after some time
become noticeable
Histopatology

 Characterized by a nonencapsulated, highly

cellular mass with abundant multinucleated
giant cells and inflammatory cells.
 Appearance is similar to giant-cell granuloma
of the jaw, but epulis has a covering of
stratified squamous epithelium
Treatment

Surgical excision of the lesion + its gingival base

Removal or modification of the irritating factor

If recurrence occurs  extraction

• 200 cases  Recurrence rate 36% for peripheral giant cell
granuloma
DISCUSSION
Discussion

 Patient, male, 36 years old was referred from RS Citra Medika Depok with chief
complaints of a lump on the upper right gingiva. Patient went to dentist and given oral
antibiotic, but didn’t show any changes. 1 month later, patient went to seek dentist and was
diagnosed between susp. Cancer / tumor / overgrowth soft tissue. 2 month later, he come to
FKG UI, and was given no medication. The lesion is sympthomatic when eating hard
texture food and cold weather. Patient chew on left side. Patient doesn’t have any smoking
habit. Systemic diseases was denied. Last visit to dentist is 5 months ago for scaling.
Patient doesn’t consume any medication. Frequently consume instand noodles twice a
week. Brush teeth only once a day during the morning. Hereditary diseases was denied.
Patient was married 6 months ago.
Discussion

 Intraoral examination show poor oral hygiene, stain, debris, and sub-supragingival calculus
 There is mild white coating on tongue
References

 Glick M. Burket’s Oral Medicine, 12e. PMPH-USA; 2015.

 Cawson R.A. Odell E.W. Cawson's Essentials of Oral Pathology and Oral Medicine. Ed.
8th. Churchill Livingstone. 2008.
 Tomic S, Dadidovic B. Peripheral giant cell granuloma – case report. Serb Dent J.
2016;63(3)
 Rodrigues SV, Mitra DK, Pawar SD, Vijayakar HN. Peripheral giant cell granuloma: This
enormity is a rarity. J Ind Soc Perio. 2015;19(4)