epulis fissuratum
TRANSCRIPT
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EPULIS FISSURATUM
By: Aleia S. Guzman
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WHAT IS EPULIS FISSURATUM?
is a benign hyperplasia of fibrous connective tissue which develops as a reactive lesion to chronic mechanical irritation produced by the flange of a poorly fitting denture
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OTHER TERMS
inflammatory fibrous hyperplasia
denture-induced fibrous inflammatory hyperplasia
denture epulis
denture injury tumor
denture induced granuloma
granuloma fissuratum
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DEFINITION OF TERMS
Epulis- is a general term for any gingival or alveolar tumor
Granuloma- a mass of granulation tissue, typically produced in response to infection, inflammation, or the presence of a foreign substance.
Tumor- a swelling of a part of the body, generally without inflammation, caused by an abnormal growth of tissue, whether benign or malignant.
er cr ysgg laser – erbium laser.
Excisional biopsy- procedure where the entire abnormality or area of interest is removed
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ETIOLOGY
Prolonged use of ill fitting denture (removable partial denture/complete denture.
Continued use of broken denture.
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DIFFERENTIAL DIAGNOSISpain bleedi
ngcolor Fast
growing
Pyogenic Granuloma
Red/pink- purple
Metastatic Neoplasms to the Oral Cavity
Reddish
Squamous Cell Carcinoma
Reddish
Epulis fissuratum pink /red
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RELATED LITERATURE
. This report presents a case of a 68-year old male patient with two soft tissue hyperplastic growths seen in the buccal vestibule in the lower anterior region. These lesions were removed using an Er,Cr:YSGG laser. The healing was uneventful and no suture or analgesic was required. The histopathological report confirmed the presurgical diagnosis. No relapse was observed till one year after surgery.
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RELATED LITERATURE
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CASE PRESENTATION
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PERSONAL DATA
Name: Lorna Gines
Address: Cabubugan, Guimbal, Iloilo City
Sex: Female
Age: 57 years old
Occupation: Massage therapist
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CHIEF COMPLAINT
“ Nabudlayan ko magkaon kai naguba akon pustiso”
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HISTORY OF PRESENT ILLNESS
20 years ago she visited a dentist because she can’t eat well due to she is partially edentulous and was fabricated a set of denture. 3 years prior to consultation her denture was destroyed while she was eating, according to her she ate something hard that cause the damaged to her denture. Despite the incident she continuously wears her denture because she can’t afford to pay a private dentist.
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MEDICAL HISTORY
The patient was admitted to the hospital in 1993 due to child birth. She has no serious illness or systemic disease and is healthy.
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PAST DENTAL HISTORY
She had her first tooth extraction year 1984 and had her last tooth extracted 3 years ago due to severe caries.
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PERSONAL AND SOCIAL HISTORY
The patient does not smoke and drink alcoholic beverages.
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X-RAY
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TREATMENT PLAN
Surgical excision on lesion
Fabrication of complete denture
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SURGICAL APPROACH
Excisional biopsy
Using:• Removal by scalpel• Electrocautery
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PRINCIPLES OF SURGERYAsepsis - Is a state of being free from disease-causing contaminants, or preventing contact with microorganism.
Attained by:Proper hand washing
Sterilizing of instruments and equipmentssss
Reusing of used equipment is contraindicated
Proper gear is needed (gloves, mask, lab gowns, head cap)
Proper infection control before and after any procedure
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PRINCIPLES OF SURGERY
Atraumatic InjuryMaintenance of patient airwayGood AnesthesiaControl of Infection
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ADVANTAGES
Tissue separation is clean with little or no bleeding.
The technique is less pressure and precise.
Planning of soft tissue is possible.
Healing discomfort and scar formation is minimal.
Access to difficult to reach area is increased.
Chair time and operator fatigue are reduced
No need to suture.
Short healing period.
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DISADVANTAGES
Cannot be used on patients with poorly shielded pacemaker
Cannot be used near flammable gasses.
Odor of burning tissue is present if high volume suction is not used.
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ARMAMENTARIUM
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ARMAMENTARIUM
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ARMAMENTARIUM
• Mouth mirror• Cheek retractor
(minesotta)• Allis forceps• Hemostat• 1% betadine• Tissue forceps• Cotton gauze• Disposable syringe• Syringe• Needle• Mask
• Gloves • Anesthetic cartridge• Topical anesthesia• Normal saline solution• Suction tip• scalpel• Kidney basin • Electrocautery• Scalpel holder • Specimen cup• Head cap and gauze
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PRE-OP INSTRUCTIONS
Get enough sleep the night before the procedure.
Take amoxicillin 500mg 1 capsule every 8hours for 7days.
Eat before the procedure.
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PROCEDURETake blood pressure
Let the patient gargle 1% betadine.
Put betadine around the patients’ mouth.
Retract.
Dry the surgical area and apply topical anesthesia.
Perform local infiltration.
Use Allis forcep to grip the lesion and slightly pull.
Using scalpel, remove the lesion with 2-3mm of normal appearing surrounding tissue and clean the area with NSS.
Put the lesion in a specimen cup with NSS for biopsy.
After removing the lesion use electrocautery to close the wound and to stop bleeding.
Recall after 7 days.
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PROCEDURE
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PROCEDURE
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PROCEDURE
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PROCEDURE
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MEDICATION
Mefenamic acid 500mg
28 caps
Sig: take 1 capsule every 6 hours for 7 days for pain or as needed.
Amoxicillin 500mg
21 caps
Sig. take 1 capsule every 8 hours for 7 days.
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POST-OP INSTRUCTIONS
Take all medications religiously 30 mins. after meal
Gargle chlorhexatedine 15 ml for 30 seconds twice a day for 2 weeks.
Avoid stressful activities.
Do not wear the denture.
Avoid touching the affected.
Avoid sipping beverages.
Soft diet for 7 days.
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RECALL
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AFTER 14 DAYS
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BIOPSY
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CONCLUSION
Surgical wound healing using electrocautery is faster compared to other techniques and the chance of epulis fissuratum recurrence is very low if new denture is fabricated.