Epulis: A Narrative Review of Epidemiology, Clinical Features, Pathogenesis, and Management

Epulis represents a group of reactive hyperplastic lesions occurring in the gingival area, distinct from true hypertrophy, as these lesions involve tissue proliferation rather than enlargement of existing cells. These lesions present significant clinical challenges in diagnosis and management.

This narrative review synthesises current literature on epulis, examining epidemiological patterns, clinical characteristics, pathogenic mechanisms, and treatment approaches across different subtypes.

Epulis primarily affects young and middle-aged adults with female predilection. The molecular pathogenesis involves complex interactions between local irritants and signalling pathways, particularly aryl hydrocarbon receptor (AhR) and RAS-PI3K-AKT-NF-κB activation. Definitive diagnosis requires histopathological examination, with fibrous, vascular, and giant cell variants exhibiting distinctive features. Surgical excision remains the primary treatment, though emerging evidence supports laser therapy, sclerotherapy, and combination approaches. Preventing recurrence necessitates elimination of local irritants, regular periodontal maintenance, and awareness of patient-specific risk factors.

Clinicians should perform thorough clinical and radiographic examinations to differentiate epulis from malignancies, and consider subtype-specific management strategies, implement comprehensive prevention protocols, and conduct long-term follow-up, especially for high-risk cases. Future research should focus on developing targeted molecular therapies, standardised treatment guidelines, and personalised recurrence prevention strategies.