Comprehensive management of factitious epulis: a report of two cases

Background: Epulis is a reactive inflammatory hyperplasia of the gingiva, commonly resulting from chronic trauma such as ill-fitting dentures, dental calculus, or self-inflicted injuries. Although benign, persistent irritation can contribute to recurrence or potential malignant transformation. This report presents two cases of epulis caused by unusual self-inflicted injuries-habitual use of a toothpick and scissors-to highlight the importance of patient education and proper oral hygiene in preventing recurrence. Case Presentation: Case 1: A 23-year-old male presented with a recurrent gingival enlargement between teeth 41 and 42, despite previous scaling and gingivectomy. Examination revealed a well-defined, reddish, firm nodule. Radiographic evaluation showed no alveolar bone involvement. The patient admitted to habitual toothpick use for food debris removal. Surgical excision and histopathology confirmed fibrous epulis. The patient was advised to stop using toothpicks and switch to dental floss. No recurrence was noted over six months. Case 2: A 43-year-old male complained of a gingival lump that grew rapidly due to a habit of prying tartar with scissors. Clinical and radiographic assessments showed a sessile nodule without bone involvement. Surgical excision was performed, and histopathology confirmed granulomatous epulis. The patient was educated on the risks of self-inflicted trauma and advised to seek professional dental care. No recurrence was observed over six months. Conclusion: Chronic self-inflicted injuries can lead to reactive gingival hyperplasia, emphasizing the need for patient education and behavioral modification. Eliminating chronic irritation and maintaining proper oral hygiene are crucial in preventing recurrence and potential malignant transformation.