Dental Epulis

Summary

Dental epulides are considered among the most common tumors of the canine mouth. Though their activity is generally considered benign, as they do not spread to distant sites, they may sometimes act invasively with respect to their neighboring tissues. In either case, their unsightly presence is far from welcome.

A dental epulus typically appears as a small, pinkish protrusion from the gum. Gum-colored and perhaps a bit knobbly in appearance, this kind of tumor has a way of insinuating itself between the teeth as it expands. It may arise from the gum as if hanging off a stalk, or sometimes as a firm ball of gummy flesh, solidly adhered to its underpinnings.

Though common in dogs (reportedly among the fourth most common tumor of the canine oral cavity), these tumors are unlikely offenders of the feline mouth, occurring only rarely in this species.

Three types of epulis are known to occur:

1. Fibromatous epulis: These epulides originate from the fibrous tissues in the mouth.

2. Ossifying epulis: This type originates from fibrous and bony tissues. These are considered precancerous with a possibility of becoming malignant osteosarcomas.

3. Acanthomatous epulis: These epulides emerge from the periodontal ligament, the tissue that holds the tooth in the bone of the jaw. Though technically benign (as are the above two types), this form is considered locally aggressive and may invade the surrounding gum tissue and underlying bone. As such, acanthomatous epulides may seriously undermine the integrity of the neighboring teeth.

Symptoms and Identification

The clinical signs of dental epulides are relegated to their appearance and space-occupying presence in the canine mouth. Sometimes smooth and shiny, other times bumpy and ulcerated, all epulides are invariably unsightly.

Initial diagnosis relies on visual inspection and dental X-rays to see the extent of local tissue damage (if any) but full histopathological examination after obtaining a specimen upon biopsy is required before a definitive diagnosis can be undertaken.

Affected Breeds

All breeds of dogs are susceptible to epulides. However, brachycephalic (short headed, snub-nosed breeds) seem predisposed. Boxers, in particular, may have a special proclivity for developing these masses.

Treatment

Treatment of an epulis lesion depends on its classification, size, and degree of local tissue damage. Surgery is typically required.

1. Fibromatous epulis: Surgical resection is recommended.

2. Ossifying epulis: Surgical removal is also recommended. However, this kind of epulis can be difficult to fully remove due to the possibility of bony attachment. Cryosurgery and laser treatments are sometimes recommended as a means of removal.

3. Acanthomatous epulis: Surgical removal is always recommended in these cases. Some may even require a procedure called a hemi-mandibulectomy (partial removal of lower jaw) or hemi-maxillectomy (partial removal of the upper jaw). Radiation is also considered a viable treatment option if the epulis is considered small.

Veterinary Cost

The cost of canine epulis treatment depends on its classification, size, and the collateral damage it's managed to inflict on its neighboring tissues.

Because the fibromatous types can be managed by most general practice veterinarians, their cost is relegated to the cost of the anesthesia, oral mass removal, histopathology fee and pain relieving medication. Invoices totaling $300 to $800 are fairly typical in these cases. Larger masses may, however, exceed this upper limit.

Unfortunately, it's not always clear which classification these epulides pertain to. In the event a pet requires follow-up surgery because what was thought to be a fibromatous epulis gets classified by the pathologist as a more aggressive lesion, additional surgery, either by board-certified veterinary dentists or board-certified veterinary surgeons, may be necessary.

In these cases, as in any case where an epulis lesion appears aggressive upon visual inspection or radiographic assessment, the cost may be significantly higher. For example, dramatic surgery of the jaw may cost upwards of three to five thousand dollars. And radiation therapy, if required, may cost six to twelve thousand dollars or more, depending on the geographic location and level of care elected.

Prevention

Prevention of these lesions is not considered feasible.

References

Bostock DE, White RAS: Classification and behaviour after surgery of canine epulides. J Comp Path 97: 197-206, 1987

Colgin LMA, Schulman FA, Dubielzig RR: Multiple epulides in 13 cats. Vet Pathol 38: 227-229, 2001

Dubielzig RR, Goldschmidt MH, Brodey RS: The nomenclature of periodontal epulides in dogs. Vet Pathol 16: 209-214, 1979

Gardner DG: Epulides in the dog: a review. J Oral Pathol Med. 25: 32-37, 1996