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Referral and warning signs
When to refer
Refer to Dental/Oral Surgery service (HC4+/RR) for excisional biopsy and histopathological confirmation.
Red flags
- Rapid growth.
- Ulceration.
- Induration (hardness).
- Fixation to underlying tissues.
- Associated pain or altered sensation.
Signs and symptoms
- Smooth-surfaced, firm, pink lump or nodule.
- Usually sessile (broad base) or pedunculated (stalk-like base).
- Typically same colour as surrounding mucosa, may be paler.
- Painless.
- Slow growing.
- Common locations: Buccal mucosa (along bite line), lateral tongue, lower lip.
Risk factors
- Chronic irritation:
- - Cheek biting / Lip biting.
- - Rubbing from sharp tooth cusp or restoration.
- - Irritation from dentures or orthodontic appliances.
Diagnosis
Clinical assessment
Diagnosis based on typical clinical appearance (smooth, firm, pink nodule) and location in an area prone to trauma/irritation. History of chronic irritation.
Differential diagnosis
- Mucocele (often bluish, fluctuant).
- Lipoma (yellowish, soft).
- Neurofibroma.
- Salivary gland tumour (benign or malignant).
- Squamous cell carcinoma (usually ulcerated/indurated).
- Pyogenic granuloma (red, vascular, bleeds easily).
Investigations
- Clinical examination.
- Excisional Biopsy: For definitive histopathological confirmation and to rule out other pathology.
Diagnostic criteria
Clinical appearance suggestive of reactive fibrous lesion, confirmed by histology.
Management
Non-pharmacological management
- Remove the source of irritation if identifiable (e.g., smooth sharp tooth, adjust denture).
Surgical Management
- Conservative Surgical Excision: Complete removal of the lesion down to the underlying tissue base. (LOC: HC4+/RR - Dental/Oral Surgery)
- Send specimen for histopathological examination.
Monitoring
Monitor healing post-excision. Monitor for recurrence if source of irritation persists.
Complications
- Rarely recur if source of irritation removed and lesion completely excised.
- Minimal risk.
Prevention
- Avoid chronic habits (cheek/lip biting).
- Ensure dental restorations are smooth.
- Ensure proper fit of dentures/appliances.
Patient education
- Reassurance about the benign nature of the lesion.
- Explanation that it's a reaction to irritation.
- Need for surgical excision for removal and confirmation.
- Importance of removing irritant source if possible.
- Minimal risk of recurrence after complete excision.
Uganda-specific notes
Common benign lesion. Referral for simple excision usually required.
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 23, Section 23.4.1 (Fibroepithelial polyp)