Epulis gravidarum: A case report

Headnote

Keywords: Epulis, gingiva, gravidarum, pregnancy

[PP-073]

Introduction: Epulis gravidarum (granuloma gravidarum) is a tumor like enlargement of the gingival or alveolar mucosa which generally occurs in the second or third trimesters. It is a benign, pink, exophytic tissue overgrowth that develops within days to weeks on a pedunculated or sessile base. It is highly vascular and bleeds easily with touching. Here we present a 36 week pregnant woman with epulis gravidarum whose lesion spontaneously regressed in the postpartum period.

Case: A 27-year-old G1P1 woman admitted for her routine prenatal care at 36 weeks of gestation. Her first pregnancy was complicated by gestational diabetes. She had her first delivery at 40th gestational week by cesarean section 11 months ago. She weighed 98 kg and her blood pressure was 130/80 mmHg. Uterine size was appropriate for gestational age. She had gestational diabetes type I-b, but her blood sugar levels were not well regulated. She did not have any other systemic diseases. While the patient was speaking, we noticed an irregular fleshy growth extending over her two upper middle Incisors (Figure 1a). After everting her upper lip and examining the gum of the upper jaw in detail, a 2 centimeters long irregular fleshy mass was detected arising from the gum and growing over her two upper middle Incisor teeth (Figure 1b). The lesion was firm to touch, non-tender and was not extending to the oral cavity. The patient had a good oral hygiene. The patient had no problem with the lesion and she stated that in her previous pregnancy a very similar lesion appeared at the same location which spontaneously disappeared in the postpartum period. At 38th gestational weeks she was delivered by cesarean section since she had regular uterine contractions. The dentist evaluating the patient had no recommendation except regular brushing of teeth. He did not plan any surgical intervention. Three weeks after the operation, we observed a significant decrease in mass size (Figure 1c).

Conclusion: Hormonal changes in pregnancy also influence the gingiva. Epulis gravidarum most probably occurs as a result of these hormonal changes. It is a simple and transient hyperplastic lesion of the gingiva which disappears spontaneously in the postpartum period and does not necessitate any surgical intervention.