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and maxillofacial pathology diagnosis and management—from page 245
Pyogenic Granuloma (Pregnancy Tumor, Granuloma Gravidarum) Discussion
vascular smooth muscle and vasodilation.5,6
Pyogenic granuloma, is considered to be a reactive vasoproliferative tumorlike growth that is most often the result of local stimulating or irritating factors. The name itself is deceiving as the lesion is not pyogenic, as there is no association with any pyogenic organisms, nor does it consist of granulomatous inflammation. Pyogenic granulomas can affect the mucosa as well as the skin, and while it can affect both the attached and unattached tissues in the oral cavity, the most common intraoral location is the gingiva.1,2 The lesion has a tendency to affect females more often than males and is more commonly seen in children and young adults.1-4 Female predilection is thought to be related to the fluctuating effects of sex hormones, specifically estrogen and progesterone, which have been observed to play a role in angiogenesis as well as have an effect on
Clinically, pyogenic granulomas most often present as a nodular or lobular exophytic lesion with a pedunculated or sessile base. The lesions can vary in size from a few millimeters to as large as several centimeter. The surface can appear smooth, but often shows evidence of ulceration or has a hemorrhagic appearance with variation in red-bluepurple coloration.1,3 While lesions can be painless, they may have a tendency to produce some local discomfort and many lesions do bleed easily upon manipulation.1,3 The typical duration of a lesion can vary, but in a large study previously published, the mean duration of the lesion was shown to be 4 months.3
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Pyogenic granulomas have a longstanding history with pregnancy, given the increased susceptibility of these individuals, and the association with the rising levels of both estrogen
Texas Dental Journal | Vol 138 | No. 4
and progesterone. The term “pregnancy tumor” or “granuloma gravidarum” has been used historically to describe epulides in pregnant females and is used synonymously for pyogenic granulomas in this clinical setting.7,8 These lesions have been observed developing more frequently within the second and third trimester, which correlates with increasing hormone levels.7,8 While the increased levels of hormones are a contributing factor, a stimulus is still thought to be necessary in many cases, such as preceding trauma or a local irritating factor, such as plaque. On occasion, some lesions have been shown to undergo resolution after childbirth as the hormonal levels drop. Another common clinical presentation of a pyogenic granuloma, termed “epulis granulomatosa”, is observed in the setting of an extraction socket.1 Clinically, the lesion will present as a vascular ulcerated mass protruding
