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Oral & Dental Health

Oral Trauma - Fibroepithelial Polyp

A common, benign reactive hyperplasia of fibrous connective tissue in response to chronic low-grade irritation or trauma.

Also known as: Irritation Fibroma, Traumatic Fibroma

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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)

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