Peripheral Exophytic Oral Lesions: A Clinical Decision Tree

Table 1

General characteristics of smooth-surfaced oral exophytic lesions of reactive origin.

Entity	Age	Gender	Site of involvement	Surface texture	Type of base	Consistency	Color	Size	Symptom & sign	Treatment	Recurrence
Pyogenic granuloma	Children/young adult	Female	Gingivae	Smooth/lobulated	Pedunculated/sessile	Soft to firm	Shiny red/pink/purple	A few mm to several cm	Asymptomatic	Conservative surgical excision	+
Pregnancy tumor	Pregnancy period	Female	Gingivae	Smooth/lobulated	Sessile	Soft to firm	Shiny red/pink/purple	A few mm to several cm	Asymptomatic	Conservative surgical excision	+
Irritation fibroma	4–6 decades	Female	Buccal mucosa	Smooth	Pedunculated/sessile	Firm or soft	Similar to adjacent mucosa	≤1.5 cm	Asymptomatic	Conservative surgical excision	Rare
Peripheral ossifying fibroma	10–19 years old	Female	Exclusively gingivae	Smooth	Pedunculated/sessile	Firm to hard	Red to pink	<2 cm	Tooth mobility; Tooth migration; Bone loss	Surgical excision down to periosteum	8–20%
Peripheral giant cell granuloma	5-6 decades	Female	Exclusively edentulous ridge & gingivae	Smooth	Pedunculated/; sessile/nodular	Firm	Bluish purple	<2 cm or >2 cm	Bone loss; Root resorption	Complete surgical excision	+
Epulis granulomatosum	>40 years	Female	Dental socket	Smooth	—	Soft to firm	Similar to adjacent mucosa	<1 cm to massive lesions	Asymptomatic	Conservative treatment/surgery	Not uncommon
Leaf-like fibroma	—	—	Palate	Smooth	Pedunculated/sessile	Firm	Pink	Up to several cm	Asymptomatic	Denture adjustment & surgical removal	Not uncommon
Epulis fissuratum	—	—	Maxillary alveolar ridge	Smooth/ulcerative	Pedunculated/sessile	Firm	Reddish	Up to several cm	Nontender/easily bleeding	Surgical excision & curettage	—
Pulp polyp	Children/young adults	—	Carious lesions of deciduous teeth & first permanent molars	Smooth	Pedunculated/sessile	Soft to firm	Red to pink	<1 cm to large masses	Discomfort	Root canal therapy/extraction	—
Giant cell Fibroma	3rd decade	Female	Gingivae	Rough surface	Pedunculated/sessile	Firm	Pink	<1 cm (often)	Asymptomatic	Conservative surgical excision	Rare
Inflammatory papillary hyperplasia	3–5th decades	Male	Palate	Pebbly/cobblestone	—	Soft to firm	Red to pink	Up to several cm	Asymptomatic/; symptomatic	Removal of denture at night/antifungals/; surgery	—