44 yr old male reports to opd wid c/o. firm painless soft tissue swelling on his lower gums. History reveals d intraoral swelling is present for more thn a year wid a slow growth rate of d soft tissue mass. patient was under homeopathic treatment. tobacco chewing habits positive, o/e. tenderness present on firm pressure over d mass, no fluid discharge, soft to firm in consistency, pedunculated, no rigid fixity to d underlying tissue, oral hygiene status appeared to b poor, generalised teeth mobility n gingival inflammation presenting features of periodontitis. patient decided to discontinue homeo treatment & willing for surgical removal of d soft tissue mass.



Good morning kind sirs and madams. Thank you revered Dr. Biswadip Shyam for posting this enigmatic case. Photograph shows a case of an adult male with INTRA-ORAL, PINKISH, WELL DEFINED, PEDUNCULATED OVAL, UN-INFLAMED SWELLING MEASURING ABOUT 3 cm x 2 cm, ARISING POSSIBLY FROM BELOW THE FREE GINGIVAL MARGIN OR INTERDENTAL PAPILLA OPPOSITE LOWER RIGHT INCISOR TEETHS MORPHOLOGICALLY CONSISTENT WITH CHRONIC, POSSIBLY BENIGN, ISOLATED REACTIVE GINGIVAL LESION [Source-Tobacco Chewing since an year], "FIBROUS EPULIS" OR "PERIPHERAL FIBROMA" in the inset of PERIODONITIS. Please note : Histologically, a fibrous epulis or peripheral fibroma may show additional focus of calcification [Peripheral calcifying fibroma], foci of cementicles [Peripheral cementifying fibroma], or trabeculae of bone [eripheral ossifying fibroma]. Thank you sirs and madams.

thanx sir

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Pyogenic granuloma Peripheral ossifying fibroma Surgical excision Biopsy

Hello I have seen few such cases D/D Pyogenic granuloma Peripheral ossifying fibroma Cementifying fibroma IOPA of lesion is taken n radiopacity if present is compared to that of lead foil kept besides d film which is shooted if no opacity den Pyogenic granuloma... n clinically Pyogenic granuloma bleeds if inflammed This seems to me Cementifying or ossifying type HP is gold standard to confirm it... Treatment is excional biopsy I don't feel it's SCC

Epulis, advised surgical removal & histopathology.

ca alveolus with positive h/o tobacco chewing, but well defined . is it mobile or not?

fixed n rigid

? Epulis...for confirmatory need a H/P aftr excisional biopsy...may b inflammatory reaction of da gingiva due to poor oral hygiene..

first of all nicely presented the case good job. I agree with Dr sinha, go for biopsy for confirmation...

DD: Fibroma epulis gingival hypertrophy most probably fibroma bt still go for biopsy for confirmation

You say it is pedunculated. If so, malignancy is unlikely. It may gingival cyst. Surgery and biopsy will help.


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