Answer:
Epulis is a non-specific, clinical designation for a localized, exophytic growth on the gingiva. However, the term has become associated with a number of disparate entities. While benign, the differential includes malignant lesions such as Kaposi's sarcoma, squamous cell, malignant mesenchymal tumors, and metastatic lesions. Excision is usually indicated if the lesion does not resolve spontaneously.
Fibrous epulis: the end result of low-grade irritation which represents an aggregate of scar tissue covered with a smooth layer of stratified squamous epithelium.
Epulis fissuratum: often seen at the borders of ill-fitting dentures. The lesion usually consists of the hyperplastic leaves of tissue between which the flange of the denture usually fits. Most are asymptomatic with a greater incidence in the maxilla than the mandible and anteriorly compared to the posterior mouth. Small, red acutely inflamed lesions may subside in 2 or 3 week if the denture is changed but larger more fibrosed lesions should be excised.
Giant cell epulis or epulis granulosatum: non-neoplastic proliferation of fibroblasts in a highly vascular stroma containing many multinucleated giant cells. It is often seen after tooth extraction and usually caused by a sharp spicule of bone left in the socket. It is often deep red or purple in color.
Pyogenic granuloma: an ulcerated inflammatory lesion usually resulting from trauma during mastication. It usually consists of a reddish papule or nodule with part of the surface rough, ulcerated, and necrotic. The name originated from the necrotic white material found in the lesion but there is no pus in a pyogenic granuloma. They may regress if the initiating cause is removed.
Epulis in pregnancy: essentially pyogenic granuloma induced by the hormonal changes associated with pregnancy. These often regress with proper oral care, but may require excision after parturition if it persists.
Congenital epulis: a rare lesion seen mostly in female newborns and in the maxilla. It does not grow after birth and may resolve spontaneously. It may need to be removed if it interferes with feeding.
Torus palatinus is a benign, slow-growing bony protuberance of the hard palate. It usually occurs in the midline and more often seen in females 2:1. It is usually symmetric and nodular with smooth contours and a broad base and covered by normal mucosa. It is often seen as a well-defined radiopaque shadow on panorex and other plain films. Removal is usually unnecessary unless prompted by psychologic or phonetic considerations.