Fogorvosi szemle, 2007 (100. évfolyam, 1-6. szám)

2007-10-01 / 5. szám

FOGORVOSI SZEMLE ■ 100. évf. 5. sz. 2007. 237-241.

Department of Oral Surgery of Kútvölgyi Hospital, Semmelweis University, Budapest'

I. Department of Pathology and Experimental Cancer Research, Research Group of Molecular Pathology,

Hungarian Academy of Sciences **

Department of Pedodontics and Orthodontics, Semmelweis University, Budapest, Hungary***

The clinical and pathological symptoms of pregnancy epulis

DR. MIHÁLY OROSZ*, DR. BÉLA SZENDE**, DR. KATALIN GÁBRIS***

Examination of the oral cavity in 2260 pregnant women revealed 12 cases of pregnancy epulis, an incidence of 0.48%. In 9 of these 12 cases, spontaneous regression and recovery occurred 1-4 months after delivery. Despite the continuous conservative therapy, several surgical interventions were necessary in the remaining 3 pregnant women, due to the large size of the epulis and the bleeding that was difficult to stop. The authors provide a detailed description of the clinical symptoms (bleeding, difficulty of oral closure, loosening and migration of teeth) caused by large, multiple epulis instances during two pregnancies of one woman, together with the surgical interventions, the histopathologic examination and the immunohistochemical characteristics of the epulis.

Key words: pregnancy epulis, pregnancy tumor, clinical symptoms, histopathology

During pregnancy many changes may occur in the oral cavity, influencing the condition of the dentition and the mucous membranes. Among others, the tendency to gingivitis [1, 13], the amount of dental plaque and the number of lactobacilli in the saliva can increase [7, 16], whereas the pH value of the saliva can decrease [12, 16].

A condition closely related to pregnancy gingivitis, pregnancy epulis (Figs. 1 and 2), has several synonyms: pregnancy tumor, epulis gravidarum, and pregnancy granuloma [3, 8, 11, 20, 23, 24], The clinical practice and pathology of pregnancy epulis are well known [6, 8]; the most important aspect is that - after birth has occurred - it spontaneously regresses or decreases in size [22, 23, 24].

As the cases described in the literature were not fully consistent with our own experience, and as only few data on the frequency of pregnancy epulis was to be found in the literature [5], our goal was to survey our knowledge of the clinical practice and pathology of pregnancy epulis by processing our experience in Hungary over the past 30 years. Pathologists, obstetricians, family doctors, general practitioners and dentists may all benefit from a consideration of this topic.

Material and method

For the past 30 years, two of the authors (MO and KG) have been providing pregnant women with dental care and dental surgery and performing the related screening examinations. Most of these were individual crosssectional examinations, with a smaller number of longitudinal (follow-up) examinations. In this study the

total number of pregnant women examined was 2260. The screening examination surveys contained questions relating to the age of the pregnant woman, the duration of pregnancy, the numbers of previous pregnancies and deliveries, the eating habits, the frequency of cleaning the teeth, and the occurrence of morning sickness. We recorded the detailed dental status (DMFT index), the Greene-Vermillion OHI-S index [9], the Russell PI index [17] and the fact of any bleeding from the gums. We also noted data relating to the occurrence of pregnancy epulis, the start of its development, the site of its occurrence, its size, and the conservative or surgical therapy applied during the course of the pregnancy and for at least 3 months following childbirth. In the cases involving longitudinal observations, the number of visits to the dentist was on average 5.5.

Results

In the course of our examinations, we encountered a total of 12 pregnancy epulis cases, i.e. a frequency of 0.48%. The sites of occurrence of the epulis were:

• in 5 cases, the region of the upper frontal teeth (Figs. 1 and 2)]

• in 5 cases the region of the lower premolars and molars;

• in 1 case, several quadrants (see Case report)] and

• in 1 case, the whole lower left quadrant (Fig. 3).

The treatment that we preferred was conservative therapy according to the protocols specified in general odontology and parodontology (regular depuration,