It has been observed that the inflammatory oral hyperplastic lesions find their similar causes as in purpuric macule. The situation of chronic irritants arises more from insultingly neglect. These include calculus, sharp-edge tooth cavities, overhanging dental restorations, overextended denture, sharp extension of bone, and chronic biting of lip and cheek. The prolonged chronic insults cause the body to produce abnormal healing tissues, called granulation tissues. Examples of these include pyogenic granuloma, hormonal tumor, traumatic hemagioma, fibroma, epulis fissuratum, epulis granulomatosum, papillary hyperplasia, and peripheral fibroma with calcification.
It is commonly known that a pile of inflamed granulation tissue is how most of the inflammatory hyperplastic lesions typically begin, when these are soft and very red in this stage. Later, as more fibrous tissues are formed, the lesion becomes harder and less reddish. If the irritant is eliminated at this stage, the inflammation disappears and the lesion shrinks noticeably. The final scar has a pale hue and the tissue gradually returns to its original softness. Microscopically, the lesion reveals granulomatous tissue covered with an intact layer of stratified squamous non-keratinized epithelium. If the covering of the lesion is traumatized, a white necrotic area usually forms in the area of the injury, and the lesion is now considered as a pyogenic granuloma.
Differential diagnosis
It is important for your dentist to make a differential diagnostic. The early inflammatory hyperplastic lesions are different from hemangioma, a metastatic tumor, a primary malignant tumor, a papilloma, condylomas, and verrucae. It is important to note that most inflammatory hyperplastic lesions, in their early stages of development, have some identifiable irritants. This characteristic irritant strengthens the impression and confirms the working diagnosis. However, if such irritant is not apparent, the possibility that the lesion is either a primary or second malignant tumor beginning below a normal epithelium should be considered in the differential diagnosis. A history of medical treatment and symptoms of a primary tumor else where may prompt the possibility of a metastatic tumor. Primary malignant tumors of the oral soft tissue are rare. Similarly, it is uncommon for a squamous cell carcinoma to appear as a small exophytic red lesion with a smooth un-ulcerated surface. In the case of lesions are located next to the jaw bone, it is most important to differentiate the inflammatory hyperplastic lesions from malignant tumors.
In the real sense of it, a traumatic hemangioma is inflammatory hyperplastic lesion. A congenital hemangioma is known to be present at the time of birth. Papilloma, condylomas, and verrucae are included here for the completeness; however, since inflammatory hyperplastic lesions are red and have basically smooth surfaces, they should be readily differentiated from the epithelial growths that are frequently white with cauliflower-like skins.
The management of lesions
When the lesions of substantial size are present, excisional biopsy is the treatment of choice. The identified irritants also need to be eliminated. Some small red lesions may also shrink to a size that precludes treatment when irritant is eliminated.
The common oral lesions
Aphthous stomatitis (Canker sores, recurrent aphthous stomatitis, RAS)
Geographic tongue (benign migratory glossitis, erythema migrans)
Lichen planus
Candidiasis (Moniliasis, Thrush)
Hairy tongue (coated tongue)
Leukoplakia
Erythroplasia (erythroplakia)
Squamous cell carcinoma (epidermoid carcinoma)
Snuff lesion (smokeless tobacco lesion)
Acquired immune deficiency syndrome (AIDS)
Amalgam tattoo
Angular cheilosis
Cementoma (periapical cemental dysplasia)
Condensing osteitis
Dental caries
Dentigerous cyst
Denture sore mouth (DSM) and Papillary Hyperplasia (PH)
Drug-induced gingival hyperplasia (Dilantin hyperplasia)
Epulis fissuratum (Inflammatory fibrous hyperplasia)
Foliate papillae
Fordyce granules
Herpes simplex virus infections
Idiopathic osteosclerosis
Irritation fibroma (traumatic fibroma)
Leukoedema
Lymphoid aggregates
Mucocele
Nasopalatine duct cyst
Necrotizing ulcerative gingivitis (Vincent’s infection, trench mouth)
Nicotine stomatitis
Osteoporotic bone marrow defect
Papilloma
Periapical cyst (radicular cyst)
Periapical dental granuloma
Peripheral giant cell granuloma
Pericoronitis
Periodontitis
Peripheral ossifying fibroma
Plaque induced gingivitis
Pulpitis
Pyogenic granuloma
Torus palatinus and torus mandibularis
Traumatic ulcer
Varix (plural: varices)
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