Table 5.
Comprehensive comparison of treatment strategies for different epulis subtypes. This table provides a consolidated overview of first-line treatments, surgical considerations, alternative therapeutic approaches, and special management considerations for fibrous epulis, vascular epulis, pregnancy epulis, and giant cell epulis. Each column highlights both common approaches and subtype-specific treatment modalities that are essential for optimal clinical management.
|
Treatment approach |
Fibrous epulis |
Vascular epulis |
Pregnancy epulis |
Giant cell epulis |
|---|---|---|---|---|
|
First-line treatment |
Surgical excision with 2 mm margins |
Surgical excision with 2 mm margins |
Conservative management until postpartum if possible |
Surgical excision with curettage or peripheral ostectomy |
|
Surgical considerations |
Standard excision including periosteum |
Removal of underlying causes; control bleeding |
Defer surgery until 2nd trimester if needed; possible postpartum resolution |
Deep excision including periodontal ligament |
|
Laser therapy Options |
Diode, CO2, Er:YAG, Nd:YAG lasers |
Diode, CO2, Er:YAG, Nd:YAG, pulsed dye lasers |
Nd:YAG laser preferred during pregnancy |
Diode laser, high-level laser therapy |
|
Minimally invasive alternatives |
May regress with removal of irritants in early lesions |
Scaling and root planing for small lesions |
Basic periodontal treatment; observation |
Ethanolamine oleate sclerotherapy |
|
Sclerotherapy |
Not typically used |
Pingyangmycin, ethanol, ethanolamine oleate, sodium tetradecyl sulphate |
Not recommended during pregnancy |
Limited evidence for effectiveness |
|
Adjunctive treatments |
Corticosteroid injection for recurrent cases |
Corticosteroid injection for recurrent cases |
Not recommended during pregnancy |
Calcitonin, α-interferon in select cases |
|
Management of defects |
CAF, CRF, SCTG, LPF, or PRF for large defects |
CAF, SCTG, LPF for aesthetic areas |
Defer reconstruction until postpartum |
CAF, SCTG for large defects |
|
Recurrence management |
Re-excision; elimination of irritants |
Re-excision with wider margins; sclerotherapy |
May recur in subsequent pregnancies |
Re-excision with peripheral ostectomy |
|
Special considerations |
Lower recurrence rate than other types |
Higher bleeding risk during excision |
Balance maternal oral health with foetal safety |
More aggressive behaviour; bone involvement |