Reactive & Soft Tissue Lesions

Irritation Fibroma (Traumatic Fibroma)

MOST COMMON oral soft tissue 'tumor' — reactive NOT neoplastic • Firm sessile nodule at bite line • Normal mucosal color

Irritation Fibroma (Traumatic Fibroma)

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Biopsy to confirm: dense avascular fibrous connective tissue with few fibroblastss

• Conservative excision; low recurrence; remove causative irritant

Pyogenic granuloma

Bright RED; bleeds easily; NOT pus-forming • PREGNANCY epulis = granuloma gravidarum • Gingival papilla most common

Most common: gingival papilla (anterior), also lips, tongue, buccal mucosa

Pyogenic granuloma

H/P: lobular capillary hemangioma pattern; abundant small blood vessels; chronic inflammatory infiltrate

Purple-BLUE gingival nodule • Mandible > max • 'Cupping' saucerization of underlying bone • From periosteum/PDL • ~10% recurrence

Peripheral giant cell granuloma

• Periapical/panoramic: superficial 'cupping' or saucerization erosion of underlying crestal bone in ~15%

• H/P: multinucleated giant cells + mononuclear ovoid cells + hemosiderin deposits in fibrovascular stroma (IDENTICAL to CGCG)

Peripheral Giant Cell Granuloma (PGCG) tx:

Excision to periosteum; curettage of underlying bone; eliminate local irritants; recurrence ~10% — re-excise

TEENAGERS/young adult FEMALES • Exclusively GINGIVAL papilla • Firm; not vascular • Calcifications in fibrous stroma • 15–20% recurrence

Peripheral Ossifying Fibroma (POF)

• H/P: cellular fibrous stroma with foci of calcification (woven bone / cementum-like calcifications / dystrophic calcification)

• Radiographic calcifications visible in 30% of cases

Mucocele

LOWER LIP most common • Minor salivary gland trauma → mucus spillage • Blue fluctuant dome • EXTRAVASATION type (no lining) vs retention (true cyst →(duct blockage → cystic dilation with epithelial lining))

Mucocele

H/P: mucin pool in CT surrounded by granulation tissue; NO epithelial lining (extravasation) OR ductal epithelial lining (retention)

Mucocele tx:

Excision including adjacent minor salivary gland tissue to prevent recurrence; marsupialization; laser ablation

Ranula

Floor of mouth ONLY • Sublingual/submandibular gland • Frog belly appearance • Plunging ranula → through mylohyoid into neck

Ranula

• MRI: cystic floor-of-mouth mass; confirms plunging extension through mylohyoid

• H/P: no epithelial lining; mucin pool; granulation tissue walls

Ranula

Marsupialization (wide fenestration); excision of sublingual gland for definitive cure; plunging ranula requires excision of sublingual gland ± neck approach

ILL-FITTING DENTURE flanges → folds of hyperplastic fibrous tissue in vestibule • 2–3 folds • Anterior vestibule most common

H/P: dense fibrous CT with chronic inflammatory infiltrate; parakeratotic epithelium

Epulis Fissuratum (Inflammatory Fibrous Hyperplasia) tx:

Remove/rebase denture for 24–48 hrs (may shrink slightly); surgical excision; fabricate new properly fitting denture

TRIAD: Pain + Punched-out papillae + FETID odor • Fusiform + Treponema (spirochetes) • 'Trench mouth' • Gray pseudomembrane

NUG / NUP (Necrotizing Ulcerative Gingivitis / Periodontitis) tx:

Debridement (gentle); H₂O₂ rinse; Metronidazole 250 mg TID x 7 days ± Amoxicillin; pain management; nutritional support; smoking cessation

Partially erupted MAND 3rd molar → food impaction under operculum • Trismus + purulent discharge → LUDWIG'S ANGINA risk if spreads

Pericoronitis

Irrigation under operculum (chlorhexidine); antibiotics if systemic signs (Amoxicillin or Clindamycin); acute phase: extraction of opposing 3rd molar; definitive: extract offending tooth or operculectomy

Juvenile Ossifying Fibroma

Aggressive ossifying fibroma in CHILDREN • Two types: Trabecular (mand) + Psammomatoid (sinonasal) • Higher recurrence than adult COF

Trabecular juvenile OF:

posterior mandible; young children; rapid expansion; cellular fibrous stroma with woven bone trabeculae

Psammomatoid juvenile OF:

sinonasal/orbital region; adolescents/young adults; concentric spherical ('psammoma') calcifications