Epulis in dogs:what lies behind a growth on the gum and how it is treated

What “epulis” means and why it is not yet a diagnosis

The word “epulis” comes from Greek and roughly means “on the gum”. It has long been used for any localised growth on the gum. Vets used to distinguish “fibromatous”, “ossifying” and “acanthomatous” epulides, but current veterinary terminology names these growths by their actual structure. That structure is determined by histopathology — examining a tissue sample under a microscope.

So if an examination report says “epulis” and no histopathology has been done yet, it simply means “a growth on the gum”. These growths are mostly found in middle-aged and older dogs, and they may hardly bother the dog for a long time. The general principles of investigating a gum growth are covered in Diagnosing a growth on the gums in a dog or cat; here I focus on epulides.

What types of epulis do dogs get?

Behind the word “epulis” there are usually three different processes. The descriptions below are not a way to diagnose at home, but an explanation of why histopathology cannot be skipped.

Peripheral odontogenic fibroma

A benign growth that arises from the periodontal ligament — the fine fibres that attach the tooth root to the bone. It used to be called a fibromatous or ossifying epulis: some of these growths contain areas resembling bone or tooth cementum.

It is usually a firm, smooth, pink growth next to a single tooth that grows slowly. It does not invade deep into the bone and does not metastasise, but it can push teeth aside, and if the ligament it grows from is left behind, it can come back.

Acanthomatous ameloblastoma

A tumour of cells related to those that form teeth; it used to be called an acanthomatous epulis. It is benign in the sense that it does not metastasise, but it is locally aggressive: it invades and destroys the jawbone and displaces and loosens teeth. It is most often found at the front of the lower jaw, near the incisors and canines.

It may look lumpy and reddish and may bleed — or it may look no different from a fibroma. Beneath the gum the process is often more extensive than it appears from above, so its margins cannot be assessed without X-rays and CT.

Reactive gingival hyperplasia

This is not a tumour but an overgrowth of the dog’s own gum tissue in response to irritation — most often long-standing inflammation caused by plaque and tartar. It can be localised, like a ridge next to one tooth, or involve the gums around many teeth. Some breeds, such as Boxers, are prone to generalised gingival hyperplasia, and some medicines can cause it.

Between the overgrown gum and the tooth, pseudopockets form — crevices where plaque builds up — so hyperplasia keeps periodontitis going. But appearances deceive here too, so areas that stand out within overgrown gums are also checked by histopathology.

What an epulis looks like and how it differs from papillomas

Owners usually notice a firm pink growth on the gum next to a tooth — smooth or lumpy, on a stalk or a broad base. It is often found by chance during toothbrushing or at a check-up. Sometimes the first sign is blood on toys, bad breath, a tooth that has shifted or become loose, or a gap between teeth that has widened.

Young dogs more often get viral papillomas: there are usually many of them, they are whitish and cauliflower-like, and they sit on the lips, tongue or cheeks. An epulis is usually single and grows from the gum, sitting tight against a tooth. But these are only clues: both epulides and malignant tumours can have a lumpy surface.

Melanoma, squamous cell carcinoma or fibrosarcoma — malignant tumours that need a different extent of treatment — can occasionally hide behind what looks like an epulis. Melanoma is not always dark; it can be pink. I write about pigmented spots in the mouth in A dark spot in a dog’s mouth. A list of possible causes of a gum growth is on the page growth or mass on the gums.

Why a biopsy, dental X-rays and CT are needed

Histopathology answers “what is it?”, and imaging answers “how deep does it go?”. Both answers are needed to plan surgery: a fibroma and an ameloblastoma are removed with different margins, and getting it wrong means either recurrence or unnecessarily extensive surgery.

Dental radiography under general anaesthesia shows whether the bone around the tooth is involved, whether the roots are displaced or being resorbed, and whether there are mineralised areas inside the growth. But an X-ray is a flat image and can underestimate how far an ameloblastoma or a malignant tumour has spread into the bone. In that case I recommend CT — computed tomography, a three-dimensional image of the jaw — to plan surgery.

A smear (cytology) is often not enough for an epulis: the dense tissue yields few cells, and the type cannot be determined from them. That is why a biopsy is needed — taking a small piece of tissue, or removing the whole growth, followed by histopathology. If histopathology shows a malignant tumour, the lymph nodes and chest are assessed before surgery and the plan is agreed with a veterinary oncologist.

1. 01

   In-clinic consultation

   I assess the growth, the neighbouring teeth and the lymph nodes under the jaw, and plan the tests needed before anaesthesia.

2. 02

   Imaging under anaesthesia

   Dental X-rays show the bone and roots; I add CT where needed.

3. 03

   Biopsy

   I take a small piece of tissue or, if the growth is small and looks like a fibroma, remove it completely together with the tooth.

4. 04

   Histopathology

   A veterinary pathologist identifies the type of growth under the microscope and, after removal, whether the margins are clear.

5. 05

   Treatment plan

   I explain the result and agree the extent of treatment with you.

How an epulis is treated: from removal with the tooth to jaw surgery

The extent of surgery depends on the type of growth, its size and what the imaging has shown. Any procedure is done under general anaesthesia with local nerve blocks (numbing the nerves in the surgical area) and pain relief afterwards, and the removed tissue is sent for histopathology.

• Peripheral odontogenic fibroma. The growth is removed together with the tooth it grows from and that tooth’s ligament, and the socket (the space where the root sat) is carefully cleaned out. Keeping the tooth can be tempting, but it raises the risk of the fibroma coming back.
• Acanthomatous ameloblastoma. It is removed with a margin of healthy tissue, often together with a section of bone and the neighbouring teeth. These operations are called partial mandibulectomy (removing part of the lower jaw) or maxillectomy (part of the upper jaw). For precise work on bone, techniques such as piezosurgery are used. If surgery is not possible, other options, including radiotherapy, are discussed with a veterinary oncologist.
• Gingival hyperplasia. The excess gum is removed and its contour restored (gingivectomy and gingivoplasty), periodontitis is treated and daily toothbrushing is put in place. If the overgrowth may be linked to medication, do not stop it yourself: discuss it with the vet who prescribed it.
• Malignant tumour. Staging (assessing whether it has spread) and wider removal are needed; the plan is made together with an oncologist.

After removal of a small growth, dogs generally start eating within the first few days; after jaw surgery, recovery takes longer. Soft food and no chew toys are needed while the wound heals. How I remove and examine oral masses, and when wider surgery is needed, is described on the page oral tumours. No one can promise an outcome in advance, but a well-planned first operation reduces the risk of needing a second one.

Can an epulis come back after removal?

It can, and the usual reason is incomplete removal: ligament left behind with a fibroma, ameloblastoma cells outside the surgical margin, or ongoing inflammation or breed tendency with hyperplasia. That is why cutting off only the visible part of the growth — without imaging or histopathology — postpones the problem rather than solving it.

After surgery the pathologist assesses the margins of the removed tissue to see whether they contain any cells of the growth. This decides whether follow-up checks are enough or a second procedure is needed. I set the frequency of check-ups according to the diagnosis, and at home it is worth lifting the lips once a month to look at the surgical site and gums — how to do this calmly is covered in How to check your pet’s mouth at home.

Where to start and what it costs

Start with an in-clinic consultation: I will assess the growth and the neighbouring teeth, explain which imaging and biopsy are needed and outline the likely extent of treatment. The exact cost of surgery can only be given after imaging and histopathology, because it depends on the type of growth and how much bone is involved. If you are not in Kyiv, start with an online consultation: send a photo of the growth next to a ruler.

Frequently asked questions