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PART II
Soft Tissue Lesion,
A
... Fig. 10-16. Pulp polyp.
characteristics are identical to those of the other types of IH lesions. Differential diagnosis Occasionally a flap of adjacent gingiva extends into a large proximal carious lesion and appears to be a chronic hyperplastic pulpitis. Careful examination, however, discloses that the exophytic growth is continuous with the gingiva rather than the pulp. The occurrence of any other type of lesion growing from the pulp is too rare to be considered in this text. Management The two ways of treating a pulp polyp are conservation of the tooth (through endodontic procedures followed by a full coverage) and extraction of the tooth. Fig. 10-15. Bluish IH and peripheral giant cell lesions (granulomas). A, Lesions on the gingiva distal to the second premolar. n, The pressure of the maxillary denture caused the lesion to be flaller than usual. (Courtesy S. Svalina, Maywood. 1\1.)
Management All lesions clinically identified as peripheral giant cell lesion should be excised with a border of normal tissue, and the specimen should be examined microscopically. Since there is some inclination to suspect the role played by chronic trauma in the formation of this lesion, all chronic irritants should be eliminated. Because of the recurrence rate of approximately 10%,27 close follow-up is indicated. Also, peripheral giant cell lesions of hyperparathyroidism may manifest as exophytic giant cell granulomas 3o .J I As a result, hyperparathyroidism and central giant cell granuloma should be considered in the workup (see Chapter 23).
Pulp Polyp An IH lesion of the pulp tissue occurs when caries have destroyed part or all the tooth crown covering the pulp chamber (Fig. 10-16). The pulp polyp (chronic hyperplastic pulpitis. pulpitis aperta) is an uncommon lesion observed mostly in the deciduous and permanent first molars of children and young adults. The lesion acquires a stratified squamous covering, apparently as the result of a fortuitous grafting of vital exfoliated epithelial cells from the adjacent oral mucosa. Its histologic
Epulis GranuJomatosum Epulis granulomatosum is the specific IH type of lesion that grows from a tooth socket after the tooth has been extracted or otherwise lost (Fig. 10-17). The precipitating cause in most cases is a sharp spicule of bone left in the walls of the socket. The growth may become apparent in a week or two after the loss of the tooth. and the clinical characteristics are similar to those of other IH lesions. Differential diagnosis The two other lesions that might be confused with an epulis granulomatosum are an antral polyp protruding into the oral cavity through a maxillary molar or premolar socket and a malignant tumor growing from a recent extraction (see Fig. 10-17). In addition. herniation of the antral membrane through an extraction site has been reported. J :! In most cases a radiograph helps the clinician identify either entity. In the case of a malignant mesenchymal lesion growing out of a recent extraction wound. a radiograph usually shows bony destruction or a combined radiolucentradiopaque lesion. The oroantral fistula that permits the extrusion of an antral polyp often is evident as a well-defined loss of bone from the antral floor. If antral polyps are present. the patient should be referred to a surgical specialist for management and for con{-irmation that the "polyp" is not an antral malignancy. Management Careful inspection of the socket and removal of any bony spicules at the time the tooth i~ ex-