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Snapshot diagnosis- what's the lump on this woman's gum?

Dr Mike Wyndham on a mouth swelling that was alarming this smoker

Dr Mike Wyndham on a mouth swelling that was alarming this smoker

The patient

This 63-year-old lady had noticed a progressive development of a swelling on her lower gum. There was some discomfort but nothing that could not be controlled by paracetamol. She wore a small denture that was supported by a tooth in poor condition.

First instinct

My initial thought was that this must be infective in origin with the tooth nearby looking pretty ‘unhappy'. But the swelling felt rather firm, which caused me some doubt. I recommended a visit to the dentist but the patient was not happy to do this at all. Was the cost an issue? She requested some antibiotics and, feeling that I had no choice, I prescribed a course of penicillin. I suspected that if I refused she would attend an A&E department.

Differential diagnosis

• Fibroma

• Epulis

Getting on the right track

I wasn't surprised when the antibiotics didn't work. The swelling looked exactly the same. However, the patient's demeanour was somewhat different from last time and she had an anguished look. Cancer was uppermost in her mind, particularly as she was a smoker. I explained that although there was clearly a lump, it felt rubbery rather than hard and did not have an infiltrative appearance. My impression was that this was a benign lesion. She agreed to be referred to the local unit for oral surgery.

Outcome

The lesion was removed and, rather as I had imagined, from first principles, the histology was benign – a granulomatous epulis. Essentially, this is a collection of granulomatous tissue that may develop as a result of local trauma from a denture or around a carious tooth. The treatment is either having the denture adjusted or removing the tooth, depending on the underlying cause.

Dr Mike Wyndham is a GP in Edgware, north London

What's this lump on the gum? What's the lump on this woman's gum? What's the lump on this woman's gum?

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