What is the FIRST step in managing epulis fissuratum?

Correct answer: A. Relieve the overextended denture flange in the affected area

• A. CORRECT. Epulis fissuratum is inflammatory fibrous hyperplasia — a reactive response to chronic trauma from an overextended or ill-fitting denture flange. The first move is always to remove the cause: relieve the offending flange, and ideally place a tissue conditioner and have the patient leave the denture out as much as possible for two to three weeks. A substantial proportion of the lesion resolves with this alone, and whatever remains can then be excised from a smaller, less inflamed field with a better cosmetic and functional result.
• B. Topical steroids have no role. This is a mechanically-induced reactive hyperplasia, not an immune-mediated condition.
• C. A new denture made over inflamed, distorted tissue will be inaccurate. Tissue health must be restored before any definitive impression is taken.
• D. Excising first means operating on inflamed, oedematous tissue while the causative trauma continues — the lesion recurs, and you have removed more tissue than was necessary because part of the bulk was reversible inflammation.

Note: The same principle governs every denture-related reactive lesion: remove the cause first, let the tissue recover, then treat what remains and only then take definitive impressions. It applies to epulis fissuratum, papillary hyperplasia and denture stomatitis alike. One caveat — any epulis fissuratum that is excised should be submitted for histopathology, since carcinoma occasionally hides in a chronically traumatised lesion.