Epulis Fissuratum Removal ADA Codes, Procedures, and Management
Epulis fissuratum, also known as denture-induced fibrous hyperplasia, is a benign overgrowth of oral soft tissue caused by chronic irritation from ill-fitting dentures. This condition typically appears as fold-like growths along the denture flange area, primarily affecting the maxillary or mandibular alveolar ridges.
Patients with epulis fissuratum often experience discomfort, difficulty chewing, and aesthetic concerns. If left untreated, the lesion can ulcerate, increasing the risk of infection. Treatment usually involves surgical excision, and dentists must use the correct ADA (American Dental Association) billing codes for insurance claims.
This article provides an in-depth look at epulis fissuratum removal, including diagnosis, treatment options, ADA codes, surgical techniques, and postoperative care.
2. Causes and Risk Factors
The primary cause of epulis fissuratum is chronic mechanical irritation from poorly fitting dentures. Other contributing factors include:
- Long-term denture use without adjustments
- Trauma from sharp denture edges
- Poor oral hygiene
- Genetic predisposition to hyperplastic tissue response
A study published in the Journal of Oral and Maxillofacial Pathology found that nearly 60% of denture wearers develop some form of mucosal irritation, with 10% progressing to epulis fissuratum.
3. Clinical Presentation and Diagnosis
Signs and Symptoms
- Pink or red, firm, fibrous tissue folds around denture borders
- Pain or tenderness when pressure is applied
- Ulceration or bleeding in severe cases
- Difficulty wearing dentures due to tissue overgrowth
Diagnostic Methods
- Clinical Examination – Visual and tactile assessment of the lesion.
- Biopsy – If malignancy is suspected (rare).
- Imaging (if needed) – To assess underlying bone involvement.
4. Treatment Options for Epulis Fissuratum
A. Surgical Excision (Most Common)
- Scalpel technique – Traditional removal with a blade.
- Electrosurgery – Minimizes bleeding.
B. Laser Therapy
- CO₂ or diode lasers provide precise excision with reduced scarring.
C. Cryotherapy
- Freezing the lesion with liquid nitrogen (less common).
Comparison of Treatment Modalities
| Treatment Method | Advantages | Disadvantages |
|---|---|---|
| Scalpel Excision | Low cost, widely available | Bleeding risk, sutures needed |
| Laser Therapy | Minimal bleeding, faster healing | Higher cost, requires specialized equipment |
| Cryotherapy | Non-invasive, minimal pain | Multiple sessions needed, less precise |
5. ADA Codes for Epulis Fissuratum Removal
The ADA Current Dental Terminology (CDT) codes for epulis fissuratum removal include:
- D7980 – Excision of hyperplastic tissue (per arch)
- D7286 – Excision of fibrous lesion (if not denture-related)
- D7999 – Unspecified oral surgery (rarely used)
Insurance Considerations:
- Most dental plans cover D7980 if medically necessary.
- Pre-authorization may be required.
6. Step-by-Step Surgical Procedure
- Local Anesthesia – Lidocaine with epinephrine for hemostasis.
- Incision – Elliptical excision around the lesion.
- Tissue Removal – Ensuring complete excision.
- Suturing – Absorbable sutures for primary closure.
- Denture Adjustment/Relining – To prevent recurrence.
7. Postoperative Care and Complications
Recovery Guidelines
- Soft diet for 3-5 days.
- Saltwater rinses to promote healing.
- Avoid denture use for 24-48 hours.
Potential Complications
- Bleeding
- Infection
- Recurrence (if denture fit isn’t corrected)
8. Prevention Strategies
- Regular dental check-ups for denture adjustments.
- Proper oral hygiene to reduce irritation.
- Using denture adhesives to minimize movement.
9. Prognosis and Long-Term Outcomes
With proper surgical removal and denture refitting, recurrence rates are less than 5%. Patients should follow up every 6 months to monitor tissue health.
10. FAQs on Epulis Fissuratum Removal
Q1: Is epulis fissuratum cancerous?
No, it is a benign lesion, but a biopsy may be needed if malignancy is suspected.
Q2: How long does recovery take after excision?
Most patients heal within 7-10 days.
Q3: Will insurance cover the removal?
Yes, if deemed medically necessary (use ADA code D7980).
11. Additional Resources
- American Dental Association (ADA) Coding Guide
- Journal of Oral and Maxillofacial Surgery – Research on hyperplastic lesions
- Denture Care Best Practices – NIH Publications
Conclusion
Epulis fissuratum is a common denture-related lesion requiring surgical removal. Proper ADA coding (D7980), precise excision, and denture adjustments ensure optimal outcomes. Prevention through regular dental visits and proper denture fit is key to avoiding recurrence.
