Periodontal Growths (Epulides) and Granulomas
The terms "epulis", "periodontoma", and "gingival overgrowth" are collective clinical terms used to designate polypoid gingival lesions of unclear etiology. In most cases, these are reactive and inflammatory processes arising in response to chronic trauma (poorly fitting crowns, overhanging restorations, decayed tooth roots).
Main types of epulides:
- Peripheral giant cell granuloma. Develops in the soft tissues of the gingiva without primary bone involvement. When large, it can cause partial resorption of the alveolar process (cupping defect on radiographs). Microscopically, it consists of fibrous tissue, myofibroblasts, mononuclear histiocytes, and multinucleated osteoclast-like cells. Sinusoidal blood flow, hemorrhages, and hemosiderin deposits are characteristic. Radical removal is required due to a high tendency to recur.
- Angiomatous epulis. Most commonly seen in children, adolescents, and pregnant individuals. It is a soft, bluish lesion with a high bleeding tendency, histologically resembling capillary hemangioma.
- Fibromatous epulis. A firm, painless pink overgrowth. It arises as an outcome of chronic productive inflammation when granulation tissue transforms into mature connective tissue.
Pyogenic granuloma and bacillary angiomatosis are clinically similar to epulides but are classified separately in modern pathology. Pyogenic granuloma has a lobular architecture (a central vessel surrounded by capillaries and fibromyxoid tissue). Bacillary angiomatosis is caused by bacteria of the genus Bartonella and is typical for patients with HIV infection.
Pathologies of the Lips and Tongue
This group of mucosal diseases includes specific inflammatory processes of the lips (cheilitis) and tongue (glossitis).
Forms of cheilitis:
- Exfoliative: affects only the vermilion border of the lips, manifesting as chronic epithelial desquamation.
- Glandular: associated with congenital heterotopia and hypertrophy of minor salivary glands with subsequent infection.
- Contact (allergic): a type IV hypersensitivity reaction (delayed-type hypersensitivity) to allergens.
- Meteorological: inflammation caused by climatic factors (wind, UV radiation, cold).
- Precancerous forms: abrasive pre-cancerous cheilitis of Manganotti and actinic cheilitis.
Forms of glossitis:
- Desquamative ("geographic tongue"): alternation of areas of epithelial desquamation and areas of regeneration, creating a specific changing pattern on the tongue.
- Rhomboid: a chronic process of unclear etiology. Manifests as the absence of papillae and papillomatosis in a strictly limited rhomboid area anterior to the sulcus terminalis.
Stomatitis
Stomatitis represents a heterogeneous group of inflammatory, infectious, and allergic diseases of the oral mucosa. A significant proportion consists of opportunistic infections caused by resident flora.
- Candidal stomatitis. Caused by Candida species in the setting of immunodeficiency, diabetes mellitus, antibiotic therapy, or poor hygiene. The acute pseudomembranous form (thrush) is characterized by white, friable plaques that, when wiped away, reveal an erythematous mucosa.
- Herpetic stomatitis. Caused by herpes simplex virus type 1 (HSV-1). Manifests as painful vesicles and ulcers. The virus can persist in a latent state within the trigeminal ganglion, reactivating under stress or ultraviolet exposure. A pathognomonic sign is multinucleated giant cells with eosinophilic intranuclear inclusions.
- Recurrent aphthous stomatitis. A chronic disease characterized by the formation of painful ulcers (aphthae) with an erythematous halo on the non-keratinized movable mucosa. The pathogenesis involves delayed-type hypersensitivity reactions.
- Drug-induced stomatitis. Develops via various hypersensitivity mechanisms: anaphylactic (Type I immediate hypersensitivity), fixed drug eruptions (Type III hypersensitivity with vasculitis), and contact reactions (Type IV delayed-type hypersensitivity).
Precancerous Lesions
It is important to distinguish between precancerous lesions and precancerous conditions. The key criterion for a precancerous lesion is the histologic identification of moderate or severe epithelial dysplasia. Modern terminology utilizes the concepts of squamous intraepithelial neoplasia (SIN) and squamous intraepithelial lesions (SIL).
Leukoplakia and keratoses are clinical terms for white (or yellowish-brown in smokers) plaques. The term "keratosis" is applied when lesions are localized to the vermilion border of the lips, hard palate, gingiva, and dorsum of the tongue; "leukoplakia" is used for other sites. Microscopy reveals basal and spinous layer hyperplasia, acanthosis, and parakeratosis.