Practice Essentials

Epulis fissuratum is a mucosal hyperplasia that results from chronic low-grade trauma induced by a denture flange.^[1] (See the image below.) Epulis fissuratum is analogous to acanthoma fissuratum of skin.

An epulis fissuratum in the anterior part of the mandible shows a central groove where the denture flange rests. Note the inflammatory erythema. The surface of the lesion is usually smooth as shown in the image.

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Pathophysiology

Epulis fissuratum arises in association with denture flanges. Consequently, epulis fissuratum is usually observed in the maxillary or mandibular vestibule.

The cause of epulis fissuratum is chronic low-grade irritation from an ill-fitting denture. Frequently, this is the consequence of resorption of the alveolar ridge so that the denture moves further into the vestibular mucosa, creating an inflammatory fibrous hyperplasia that proliferates over the flange.^[2]

Epidemiology

A study on the prevalence of oral lesions among 210 denture wearers found that oral lesions were found in 20.5% of the cases and that denture-induced fibrous hyperplasia was the most common type of lesion detected (41.9%).^[3]

Sex- and age-related demographics

Most studies indicate a clear predilection for epulis fissuratum in females.^[4]Possible atrophic epithelial changes secondary to menopause may influence an increased reaction to trauma in older females.

Epulis fissuratum occurs in greatest numbers in the fifth, sixth, and seventh decades, but it can be observed at almost any age. Epulis fissuratum has been described in children. The fact that the lesions are related to denture wear and chronicity of an irritative process explains the higher incidence in older individuals.

Prognosis

With correction of the poorly fitting denture, the prognosis for epulis fissuratum is excellent.

Morbidity/mortality

Significant morbidity does not occur with epulis fissuratum.

Patient Education

Instruct the patient that regular dental care is necessary and that the oral tissues are changing constantly. This means that dentures are not permanent and need adjustments over time.

Clinical Presentation

Bhattacharyya I. Case of the month. Epulis fissuratum. Todays FDA. 2008 Jul. 20(7):15, 17, 19. [QxMD MEDLINE Link].
Coelho CM, Zucoloto S, Lopes RA. Denture-induced fibrous inflammatory hyperplasia: a retrospective study in a school of dentistry. Int J Prosthodont. 2000 Mar-Apr. 13(2):148-51. [QxMD MEDLINE Link].
Mubarak S, Hmud A, Chandrasekharan S, Ali AA. Prevalence of denture-related oral lesions among patients attending College of Dentistry, University of Dammam: A clinico-pathological study. J Int Soc Prev Community Dent. 2015 Nov-Dec. 5 (6):506-12. [QxMD MEDLINE Link].
Buchner A, Begleiter A, Hansen LS. The predominance of epulis fissuratum in females. Quintessence Int. 1984 Jul. 15(7):699-702. [QxMD MEDLINE Link].
Keng SB, Loh HS. Clinical presentation of denture hyperplasia of oral tissues. Ann Acad Med Singapore. 1989 Sep. 18(5):537-40. [QxMD MEDLINE Link].
Ralph JP, Stenhouse D. Denture-induced hyperplasia of the oral soft tissues. Vestibular lesions, their characteristics and treatment. Br Dent J. 1972 Jan 18. 132(2):68-70. [QxMD MEDLINE Link].
Cutright DE. The histopathologic findings in 583 cases of epulis fissuratum. Oral Surg Oral Med Oral Pathol. 1974 Mar. 37(3):401-11. [QxMD MEDLINE Link].
Naveen Kumar J, Bhaskaran M. Denture-induced fibrous hyperplasia. Treatment with carbon dioxide laser and a two year follow-up. Indian J Dent Res. 2007 Jul-Sep. 18(3):135-7. [QxMD MEDLINE Link].
de Arruda Paes-Junior TJ, Cavalcanti SC, Nascimento DF, Saavedra Gde S, Kimpara ET, Borges AL, et al. CO(2) Laser Surgery and Prosthetic Management for the Treatment of Epulis Fissuratum. ISRN Dent. 2011. 2011:282361. [QxMD MEDLINE Link]. [Full Text].
Eroglu CN, Tunç SK, Elasan S. Removal of epulis fissuratum by Er,Cr:YSGG laser in comparison with the conventional method. Photomed Laser Surg. 2015 Nov. 33 (11):533-9. [QxMD MEDLINE Link].
Ortega-Concepción D, Cano-Durán JA, Peña-Cardelles JF, Paredes-Rodríguez VM, González-Serrano J, López-Quiles J. The application of diode laser in the treatment of oral soft tissues lesions. A literature review. J Clin Exp Dent. 2017 Jul. 9 (7):e925-e928. [QxMD MEDLINE Link]. [Full Text].
Vyasarayani P, Madhumietha A, Gundlapalle P. Management of geriatric patient with epulis fissuratum using liquid nitrogen cryosurgery: a case report. J Indian Prosthodont Soc. 2014 Mar. 14 (1):115-9. [QxMD MEDLINE Link]. [Full Text].
Mohan RP, Verma S, Singh U, Agarwal N. Epulis fissuratum: consequence of ill-fitting prosthesis. BMJ Case Rep. 2013 Jul 17. 2013:[QxMD MEDLINE Link].

Media Gallery

An epulis fissuratum in the anterior part of the mandible shows a central groove where the denture flange rests. Note the inflammatory erythema. The surface of the lesion is usually smooth as shown in the image.
The mass in the posterior part of the maxillary vestibule is associated with a full denture; however, in this patient, the mass represented a squamous cell carcinoma. The surface is more granular in appearance, although this is not always the case.
A view of a whole mount of a tissue section taken from an epulis fissuratum shows that it is essentially a fibrous hyperplasia. The central groove can be observed, and, in this patient, papillary hyperplasia is present in some areas.