Management of Fibrous Hyperplasia in Geriatric Patient with Hypertension: A Case Report
Background: Fibrous hyperplasia or epulis fissuratum is a name related to reactive tissue response to chronic irritation and trauma caused by dentures that are not properly attached. Persistent trauma to the oral mucosa can cause a carcinoma. The treatment management of epulis fissuratum becomes very challenging for geriatric patients.
Objective: To discuss the treatment of fibrous hyperplasia in geriatric patients with a history of hypertensive disease.
Case Report: A 63-year-old woman with a history of hypertension presented to the Periodontia Department of Hasanuddin University Dental and Oral Health Hospital with complaints of swollen gingiva, the enlargement beginning ±6 months prior. Clinical examination showed a gingiva 4×1×0.6 cm in diameter along the alveolar linger ridge of the right lower jaw. The inflammation in the gingiva was suspected to be fibrous hyperplasia/epulis fissuratum. The treatment procedure performed was excision of the epulis and administration of cyanoacrylate.
Results: One week and one month postoperatively, a good healing process and excellent result with no more gingival enlargement were reported.
Conclusion: The management of fibrous hyperplasia with prevention strategies as well as excision and administration of cyanoacrylate is an effective procedure for bleeding control and to accelerate healing in geriatric patients with a history of hypertension.
Keywords: epulis fissuratum, fibrous hyperplasia, geriatric, hypertension
 Mohan RPS, Verma S, Singh U, Agarwal N. Epulis fissuratum: Consequence of illfitting prosthesis. BMJ Case Reports. 2013;20(2) : 1–2. https://doi.org/10.1136/bcr- 2013-200054
 Agrawal AA. Gingival enlargements: Differential diagnosis and review of literature. World Journal of Clinical Cases. 2015;3(9):779-788. https://doi.org/10.12998/wjcc.v3.i9.779
 Kokubun K, Matsuzaka K, Akashi Y et al. Congenital epulis: A case and review of the literature. The Bulletin of Tokyo Dental College. 2018;59(2):127–132. https://doi.org/10.2209/tdcpublication.2017-0028
 Gillam, DG. Surgical excision of an epulis: Case report. Advances in Dentistry & Oral Health. 2018;9(4):129–131. https://doi.org/10.19080/adoh.2018.09.555770
 Southerland JH, Gill DG, Gangula PR, Halpern LR, Cardona CY, Mouton CP. Dental management in patients with hypertension: Challenges and solutions. Clinical, Cosmetic and Investigational Dentistry. 2016;8(1):111–120. https://doi.org/10.2147/CCIDE.S99446
 Ferdinand KC, Nasser SA. Management of essential hypertension. Cardiology Clinics. 2017;35(2):231–246. https://doi.org/10.1016/j.ccl.2016.12.005
 Zhu Y, Zhang H, Li C. The clinical application of partial removal periodontal surgery in the therapy of epulis. Medicine. 2019;98(27):1-3. https://doi.org/10.1097/MD.0000000000016107
 Vaques PG, Salas JE, Moreno SE, Montero RA, Roig AM, Lopez J. Inflammatory papillary hyperplasia: A systematic review. Medicina Oral, Patologia Oral y Cirugia Bucal. 2017;22(1):36–42. https://doi.org/10.4317/medoral.21405
 Jackson GL, Weinberger M, Karen M. Open label randomized trial of titrated disease management for patients with hypertension: Study design and baseline sample characteristics. Contemporary Clinical Dentistry. 2017; 50(1):5–15. https://doi.org/10.1016/j.cct.2016.07.009
 Samadian F, Dalili N, Jamalian A. Lifestyle modifications to prevent and control hypertension. Iranian Journal of Kidney Diseases. 2016;10(5):237–263.
 Yancey R. Anesthetic management of the hypertensive patient: Part I. Anesthesia Progress. 2018;65(2):131–138. https://doi.org/10.2344/anpr-65-02-12
 Yancey R. Anesthetic management of the hypertensive patient: Part II. Anesthesia Progress. 2018;65(3):206–213. https://doi.org/10.2344/anpr-65-03-17
 Di Palo KE, Kish T. The role of the pharmacist in hypertension management. Current Opinion in Cardiology. 2018;33(4):382–387. https://doi.org/10.1097/HCO.0000000000000527
 Borie E, Rosas E, Kuramochi G, Etcheberry S, Olate S, Weber B. Oral applications of cyanoacrylate adhesives: A literature review. BioMed Research International. 2019;3(1):1-6. https://doi.org/10.1155/2019/8217602
 Fadaie P, Atai M, Imani M, Karkhaneh A, Ghasaban S. Cyanoacrylate-POSS nanocomposites: Novel adhesives with improved properties for dental applications. Dental Materials. 2013;29(6):61–e69. https://doi.org/10.1016/j.dental.2013.03.003
 Torres R, Christina R, Gomes B et al. Use of cyanoacrylate in the coaptation of edges of surgical wounds. Anais Brasileiros de Dermatologia. 2012;87(6):871–876.