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Oral Pyogenic Granuloma Clinical Presentation

  • Author: John A Svirsky, DDS, MEd; Chief Editor: William D James, MD  more...
 
Updated: Jun 10, 2016
 

History

Early lesions bleed easily due to extreme vascularity. Pyogenic granulomas can have a rapid growth pattern that can cause alarm. If left alone, a number of pyogenic granulomas undergo fibrous maturation and resemble and/or become fibromas.

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Physical

The typical lesion involves the interproximal gingiva and increases in size to cover a portion of the adjacent teeth. The maxillary gingiva (especially in the anterior region) is involved more frequently than the mandibular gingiva; the facial gingiva is involved more than the lingual gingiva. A number of lesions affect both the facial and lingual gingivae.

Pyogenic granulomas usually present as smooth or lobulated red-to-purple masses that may be either pedunculated or sessile. As lesions mature, the vascularity decreases and the clinical appearance is more collagenous and pink. Pyogenic granulomas vary in size from a few millimeters to several centimeters and are painless. These tumors are soft to palpation.

Note the images below.

Pyogenic granuloma of the anterior maxilla showingPyogenic granuloma of the anterior maxilla showing a small amount of involvement on the buccal gingiva of teeth numbers 8 and 9 with most of the lesion on the lingua. Note that indentations from the lower teeth are on the surface of the tumor.
Pyogenic granuloma of the dorsal tongue in a 52-yePyogenic granuloma of the dorsal tongue in a 52-year-old black woman. An area of geographic tongue is adjacent to the pyogenic granuloma.
Pyogenic granuloma associated with teeth numbers 2Pyogenic granuloma associated with teeth numbers 20 and 21 in a 27-year-old white woman who is 8 months pregnant. The lesion was excised without curetting the area to remove irritants.
Same patient as in Image 4 with a lesion that recuSame patient as in Image 4 with a lesion that recurred almost immediately. This picture was taken 1 month after the birth of her child.
Rapidly growing pyogenic granuloma in the area of Rapidly growing pyogenic granuloma in the area of teeth numbers 20 and 21 in a 13-year-old black girl. Notice the calculus and plaque on tooth number 22. The lesion was soft to palpation.
Pyogenic granuloma on the facial gingiva of teeth Pyogenic granuloma on the facial gingiva of teeth numbers 7 and 8. This is a long-standing lesion that is becoming fibrosed and less vascular. Notice the pink coloration at the base of the lesion.
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Causes

A history of trauma is common in extragingival sites, whereas most lesions of the gingiva are a response to irritation.[2] Individuals with poor oral hygiene and chronic oral irritants (eg, overhanging restorations, calculus) most frequently are affected.

In 2010, a case of pyogenic granuloma was reported around an implant. This will be a more common occurrence as the number of implants and associated peri-implantitis continues to increase.[3]

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Contributor Information and Disclosures
Author

John A Svirsky, DDS, MEd Director of Oral Pathology Diagnostic Service, Professor of Oral and Maxillofacial Pathology, Virginia Commonwealth University School of Dentistry

John A Svirsky, DDS, MEd is a member of the following medical societies: American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kelly M Cordoro, MD Assistant Professor of Clinical Dermatology and Pediatrics, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Medical Society of Virginia, Society for Pediatric Dermatology, Women's Dermatologic Society, Association of Professors of Dermatology, National Psoriasis Foundation, Dermatology Foundation

Disclosure: Nothing to disclose.

References
  1. Sills ES, Zegarelli DJ, Hoschander MM, Strider WE. Clinical diagnosis and management of hormonally responsive oral pregnancy tumor (pyogenic granuloma). J Reprod Med. 1996 Jul. 41(7):467-70. [Medline].

  2. Vilmann A, Vilmann P, Vilmann H. Pyogenic granuloma: evaluation of oral conditions. Br J Oral Maxillofac Surg. 1986 Oct. 24(5):376-82. [Medline].

  3. Olmedo DG, Paparella ML, Brandizzi D, Cabrini RL. Reactive lesions of peri-implant mucosa associated with titanium dental implants: a report of 2 cases. Int J Oral Maxillofac Surg. 2010 May. 39(5):503-7. [Medline].

  4. Acharya PN, Gill D, Lloyd T. Pyogenic granuloma: a rare side complication from an orthodontic appliance. J Orthod. 2011 Dec. 38(4):290-3. [Medline].

  5. Bhaskar SN, Jacoway JR. Pyogenic granuloma--clinical features, incidence, histology, and result of treatment: report of 242 cases. J Oral Surg. 1966 Sep. 24(5):391-8. [Medline].

  6. Eisen D, Lynch DP. The Mouth: Diagnosis and Treatment. St. Louis, Mo: Mosby; 1998. 58-60.

  7. Kamal R, Dahiya P, Puri A. Oral pyogenic granuloma: Various concepts of etiopathogenesis. J Oral Maxillofac Pathol. 2012 Jan. 16(1):79-82. [Medline]. [Full Text].

  8. Neville BW, Damm DD, Allen CM, Bouquot JE. Oral & Maxillofacial Pathology. Philadelphia, Pa: WB Saunders; 2002. 447-9.

  9. Neville BW, Damm DD, White DK. Color Atlas of Clinical Oral Pathology. Baltimore, Md: Lippincott Williams & Wilkins; 1999. 284-5.

  10. Sapp JP, Eversole LR, Wysocki GP. Contemporary Oral and Maxillofacial Pathology. 2nd ed. St. Louis, Mo: Mosby; 2003.

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Typical appearance of a pyogenic granuloma involving the buccal gingiva of teeth numbers 20 and 21. Note the extreme vascularity.
Pyogenic granuloma of the anterior maxilla showing a small amount of involvement on the buccal gingiva of teeth numbers 8 and 9 with most of the lesion on the lingua. Note that indentations from the lower teeth are on the surface of the tumor.
Pyogenic granuloma of the dorsal tongue in a 52-year-old black woman. An area of geographic tongue is adjacent to the pyogenic granuloma.
Pyogenic granuloma associated with teeth numbers 20 and 21 in a 27-year-old white woman who is 8 months pregnant. The lesion was excised without curetting the area to remove irritants.
Same patient as in Image 4 with a lesion that recurred almost immediately. This picture was taken 1 month after the birth of her child.
Rapidly growing pyogenic granuloma in the area of teeth numbers 20 and 21 in a 13-year-old black girl. Notice the calculus and plaque on tooth number 22. The lesion was soft to palpation.
Pyogenic granuloma on the facial gingiva of teeth numbers 7 and 8. This is a long-standing lesion that is becoming fibrosed and less vascular. Notice the pink coloration at the base of the lesion.
 
 
 
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