CLINICAL EVALUATION AND MANAGEMENT OF EPULIS GRAVIDARUM FROM OBSTETRIC AND ORAL SURGICAL PERSPECTIVES
Ruhide AZEMI NEZIRI, Bunjamin XHAFERI, Slagjana SIMEONOVA KRSTEVSKA, Jeton NEZIRI, Muhamed TAIRI, Gajur SHABANI
Abstract
Epulis gravidarum is a benign, non-neoplastic and self-limiting oral lesion, which occurs during pregnancy due to hormonal changes, mainly from estrogen and progesterone. Contributing factors are increased vascularization from the antihypertensive therapy, poor oral hygiene that contributes in the formation of plaque and calculus. Consequences include bleeding, secondary infection and also difficulties in mastication and speech.
Fetal complications arising from this maternal oral pathology are intrauterine growth restriction (IUGR), low birth weight, preterm rupture of fetal membranes, preterm uterine contractions thus resulting in preterm labor.
Our case report is about a thirty five year old pregnant woman, with her fourth pregnancy. She developed an oral lesion in the anterior mandibular region during the second trimester of her last pregnancy. The gingival mass was approximately 3 cm, and was following with spontaneous and provoked bleeding. From the anamnesis, the patient gave us information about chronic hypertension which was managed with Tbl. Enalapril prenatally, and Tbl. Methyldopa perinatally.
Perinatally the patient was followed by an oral surgeon and obstetrician, and was decided for conservative management of the gingival mass until delivery. Surgical operation was performed several months after delivery, using electrocautery and the histopathological material excised was used to confirm the diagnosis.
Conservative oral management and regular follow up by an obstetrician during pregnancy are with crucial importance, because delayed treatment can lead to maternal and fetal complications. Surgical excision is preferred after delivery to minimize risks of hemorrhage and recurrence.
Pages: 268 - 272