Introduction:
The human body encounters a lot of growths in which the oral cavity is also not lagging. These growths can occur at any site in the oral cavity, namely gums, cheeks, or lips (both upper and lower). The majority of them are painless and benign in nature. They even resemble the native tissue. Hence, individuals are least concerned with their potential to turn malignant (cancerous). In the beginning, the size is very small and often non-aggressive. But later, some can undergo dysplastic changes and become untreatable tumors. These conditions may appear as mucocele, cystic swelling, or lipoma, which is popularly called a universal tumor.
What Are the Common Oral Growths?
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Lipoma: It is popularly called a universal tumor, which affects males more than females. It is a benign tumor of mesenchymal cells and is associated with certain syndromes like neurofibromatosis or Gardner syndrome. Histopathology depicts the presence of adipocytes. The majority of oral lipomas (50 %) are found in the buccal mucosa followed by the tongue, floor of the mouth, buccal sulcus (or vestibule), palate, lip, and gingiva. It commonly affects people between the ages of 40 and 50 years. There are a variety of causes suggested for lipoma, among which prime reasons are trauma, infection, chronic irritation, and hormonal imbalance.
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Fibroma: Fibromas are defined as slow-growing and asymptomatic benign tumors of connective tissue origin occurring most frequently in buccal mucosa with females commonly affected. Histologically they show proliferation of fibroblast and collagen fibers. The primary cause of fibroma is chronic irritation characterized by cheek or lip biting or ill-fitting dentures. The appearance is usually firm and nodular, but they can be soft also, and the color is comparatively lighter than the surrounding due to reduced vascularity.
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Mucocele: Mucocele refers to a non-cancerous slow-growing bluish or translucent swelling. The etiology of mucocele is either disruption or blockage of the salivary gland ducts (predominantly minor salivary glands). It could be followed by extravasation and collection of mucins in the connective tissue. Another reason that is associated with this lesion is local trauma. However, it can be due to unknown reasons also. There is no gender prediction stating both males and females are equally affected. It occurs most commonly in the inner aspect of the lower lip, but in some cases, it can also occur in buccal mucosa, tongue, and floor of the mouth.
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Pyogenic Granuloma: It is a non-neoplastic inflammatory hyperplastic growth of the connective tissue which arises due to an exaggerated response towards either a localized lesion or continuous irritation like the presence of calculus or defective restorations, traumatic injury, and hormonal disturbances. This lesion's appearance is an exophytic growth with a smooth and shiny surface having numerous hemorrhagic papules that may show ulcerated appearance also. Histologically, it shows the presence of vascular proliferation lined by thick endothelial cells with epithelium ranging from being hyperplastic to thin or even ulcerated. The most common site of occurrence for pyogenic granuloma is gingiva, followed by lips, tongue, palate, and buccal mucosa. Radiographic changes may occur but at a very later stage.
What Are the Differential Diagnosis of Oral Growth?
Mucocele and fibroma can pose a diagnostic challenge because of their resemblance to pathologies like peripheral ossifying fibroma, hemangioma, or lipoma. For firm diagnosis, histopathological examination and correlation with the clinical presentation is a must.
Pyogenic granuloma is associated with a preference for gingiva and occurs in the young age group compared to lipoma, which shows a tendency to the buccal mucosa and older age group at 40 to 50 years. Similarly, peripheral ossifying fibroma has a preference for the maxillary anterior region. It occurs in the age group of 20 to 30 years, while lipoma predominantly occurs on buccal mucosa at 40 to 50 years. As compared to pyogenic granuloma, peripheral ossifying fibroma has irregular borders, and the consistency is hard most of the time.
Mucocele occurs in any gender, while fibroma occurs predominantly in females. A fibroma is lighter in color, but pyogenic granuloma is bright red in color. Lipoma has a yellowish-orange appearance, while hemangioma has a bluish-red tinge. Hemangioma occurs in childhood with the preference on the tongue, while papilloma shows predominance on the gingiva.
What Is the Treatment of Oral Growth?
Although the lesions are benign in nature, they may interfere with speech and mastication and can cause a lot of discomfort by making eating difficult. Even esthetics is compromised. Treatment comprises both surgical and non-surgical phases. Non-surgical treatment involves the removal of local irritants by scaling and root planing of the adjacent teeth. It is followed by surgical treatment, which includes marsupialization, laser ablation, and excision by scalpel or electrosurgery.
Excision by a laser has an advantage of minimal postoperative pain, minimal bleeding, no need for suturing the site, and excellent healing within a week. However, the chances of recurrence are more with lasers than electrocautery or scalpel.
The best treatment for almost all the benign growths is simple surgical complete excision followed by recalls and minimum follow-ups for at least six months to a year.
Conclusion
Clinicians often encounter a large number of overgrowths in the oral cavity. These growths could be in a group or in isolation. Every enlargement should be biopsied as early as possible so that the chances of its malignant transformation are reduced. Further, the treatment options should be well updated with all the clinicians for a perfect prognosis and good results. Recalls are necessary for the patient because different individuals have different genetic as well as environmental susceptibility to particular irritants.
