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MINISTERUL SNTII AL REPUBLICII MOLDOVA

USMF N. TESTEMIANU
Catedra Obstetric i ginecologie FECMF

BOLILE STOMATOLOGICE
I SARCINA
EPULIS GRAVIDARUM

Studenta gr.S1208: Prunici Elena


Profesori: Cau Ctlin, Railean Ludm

Granulomul de sarcin (epulis


gravidarum)/ granulomul oral al
gravidelor (oral granuloma gravidarum
(OGG))este o formaiune nodular
pseudotumoral unic, de culoare violetalbstruie, cu diametrul de pn la 2
cm, localizat la nivelul papilelor
interdentare. Se manifest printr-o
tendin crescut la ulcerare i
hemoragie.

Enulis- tumoarea evolueaz ntre gingie i


dini putnd provoca dislocarea acestora.

Particulariti
structurale:
Apare ca o excrescen sesil
pediculat, de consisten ferm
sau spongioas;

Poate avea diferite dimensiuni de


la civa mm la 2-3 cm i mai mult
n diametru, preponderent n
partea vestibular a cavitii
bucale;
Poate avea culoare identic
gingiei, sau nuan roie-brun,
cianotic etc.;
Dup aspect histologic: structur
fibromatoas, papilomatoas,
hemangiomatoas, osteomatoas
sau chiar nevic.

Etiopatogenie:
Cauzat de modificrile hormonale
din timpul sarcinii: nivelul crescut
gingival de progesteron activ
asociat cu igiena defectuoas.
Nivelul crescut de estrogen i
progesteron cresc nivelul de
Prevotella intermedian biofimul
subgingival, crete permeabilitatea
vascular, favoriznd infiltrarea
fluidelor n esutul perivascular,
amplificnd rspunsul inflamator cu
rol important n evoluia formaiunii.
Afeciunea apare la aproximativ 5%
din femeile nsrcinate, de obicei pe
fondul unei gingivite deja existente.

Caz clinic:
Case presentation
The patient, a 41-year-old woman, presented to the
dentistry department with difficulty in chewing due to
the presence of tender masses in her mouth since 13
months, which started to appear during the end of the
first trimester of her newly born child. Her medical
history was non-contributory. Extraoral examination
revealed bilateral submental and submandibular
lymphadenitis. On oral examination she had very poor
oral hygiene with heavy calculus deposits, severely
inflamed gingiva and periodontally involved teeth with
high grade of mobility. Halitosis was very marked with
foul malodour measuring the highest score of five on
Rosenberg and McCulloch3organoleptical scoring scale.
There were two pedunculated non-tender lobulated
masses, with the largest arising from the anterior
mandibular gingiva of the permanent incisors and the
smallest arising from the gingiva of the mandibular right
second permanent molar. Both masses had a
haemorrhagic base in continuity with severely inflamed
gingiva, and interfering with normal mastication and
occlusion, resulting in subsequent chronic trauma from
opposing teeth. The anterior mass had a deep creamy
reddish colour, more than the smaller posterior mass (
figure 1A,B).
Figure1
(A) Anterior mandibular mass with haemorrhagic base
and extending to the incisal edges of lower incisors. (B)
Posterior mandibular mass in molar area interfering with
normal posterior occlusion.

Diagnostic difereniat:

Gingivita hiperplazic focal


Fibroma
Fibroma periferic osifiant
Granulom gigantocelular
periferic
Hemangioma
Kaposi sarcoma
angiosarcoma
Limfoma non-Hodgkinean
Cancer metastatic

Tratament:
Necesitatea tratamentului chirurgical
n timpul sarcinii trebuie analizat
atent, innd cont de rata nalt de
recidiv precum i de regresie dup
natere a formaiunii, datorit
normalizrii nivelului hormonal. n
general se recurge la tratament
chirurgical n timpul sarcinii dac
formaiunea produce perturbri
funcionale i estetice, dar e de
preferat s se efectueze dup
natere. Apare necesitatea
controlului biofilmului bacterian n
timpul tratamentului.

Tratament:
Fiind prezente mase de natur hemoragic
secundar infectate, au fost prescrise antibiotice
orale (amoxicillin 500mg i metronidazole 500
mg de 3 ori pe zi ,timp de 1 sapt.) cu 0.2%
gluconate chlorhexidina sub form de ap de
gur i luarea n consideraie a igienei orale.
Biopsia excizional chirurgical a ambelor
formaiuni cu anestezierea bilateral a nervului
mentonier, lingual, drept alveolar inferior i n.
bucal(articaine 4% cu 1:100000 adrenalina)
efectuat sub anestezie general cu extracia
dinilor mobili mandibulari anteriori. S-au aplicat
suturi cu fir resorbabil i s-a efectuat hemostaza
local.
Examenul histopatologic a identificat formaiuni
polipoide acoperite cu epiteliu scuamos, cu arii
de ulceraii extinse i esut granular inflamator
sub form de granulom piogen.(A,B).
Figura
(A)pierderi epiteliale focale cu proliferarea
subepitelial a vaselor neoformate i infiltrat

Rezultate :
Aspect intraoral
la 2 sptmni
postoperator cu
reducia
inlflamaiei
gingivale

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