eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa
Oral Pyogenic Granuloma
Updated: Oct 28, 2008
Introduction
Background
The pyogenic granuloma is a relatively common, tumorlike, exuberant tissue response to localized irritation or trauma. The name pyogenic granuloma is a misnomer since the condition is not associated with pus and does not represent a granuloma histologically. It is a reactive inflammatory process filled with proliferating vascular channels, immature fibroblastic connective tissue, and scattered inflammatory cells. The surface usually is ulcerated, and the lesion exhibits a lobular architecture.
Two lesions, peripheral ossifying fibroma and peripheral giant cell granuloma, are clinically identical to the pyogenic granuloma when they occur on the gingiva. If 100 biopsies of pyogenic granuloma–appearing lesions of the gingiva are submitted for histologic examination, approximately 85% will be pyogenic granulomas, 10% will be peripheral ossifying fibromas, and 5% will be peripheral giant cell granulomas. The pyogenic granuloma can occur anywhere in the oral cavity, whereas the peripheral ossifying fibroma and peripheral giant cell granuloma only occur on the gingiva or alveolar mucosa. The clinical appearance, treatment, and prognosis are the same for all 3 entities.
Pathophysiology
The pyogenic granuloma most frequently develops on the buccal gingiva in the interproximal tissue between teeth. Three quarters of all oral pyogenic granulomas occur on the gingiva, with the lips, tongue (especially the dorsal surface), and buccal mucosa also affected. A history of trauma is common in extragingival sites, whereas most lesions of the gingiva are a response to irritation. Individuals with poor oral hygiene and chronic oral irritants (eg, overhanging restorations, calculus) most frequently are affected.
Frequency
International
Lesions have a similar frequency throughout the world.
Mortality/Morbidity
Mastication on the lesion can cause bleeding and pain and can require surgical intervention before parturition in lesions associated with pregnancy.1
Race
No racial predilection is reported.
Sex
Females are far more susceptible than males because of the hormonal changes that occur in women during puberty, pregnancy, and menopause. The pyogenic granuloma has been called a "pregnancy tumor" and does occur in 1% of pregnant women. (The Medscape Pregnancy Resource Center may be of interest.)
- When possible, wait until after delivery to remove the lesion in pregnant women because of a greater tendency for recurrence during pregnancy.
- In a number of cases, mastication on the lesion causes bleeding and pain and requires surgical intervention before parturition.
- Some pyogenic granulomas regress after childbirth without surgical intervention.
Age
Pyogenic granulomas occur at any age, but they most frequently affect young adults.
Clinical
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.
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.
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.
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References
Sills ES, Zegarelli DJ, Hoschander MM, Strider WE. Clinical diagnosis and management of hormonally responsive oral pregnancy tumor (pyogenic granuloma). J Reprod Med. Jul 1996;41(7):467-70. [Medline].
Vilmann A, Vilmann P, Vilmann H. Pyogenic granuloma: evaluation of oral conditions. Br J Oral Maxillofac Surg. Oct 1986;24(5):376-82. [Medline].
Bhaskar SN, Jacoway JR. Pyogenic granuloma--clinical features, incidence, histology, and result of treatment: report of 242 cases. J Oral Surg. Sep 1966;24(5):391-8. [Medline].
Eisen D, Lynch DP. The Mouth: Diagnosis and Treatment. St. Louis, Mo: Mosby; 1998:58-60.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral & Maxillofacial Pathology. Philadelphia, Pa: WB Saunders; 2002:447-9.
Neville BW, Damm DD, White DK. Color Atlas of Clinical Oral Pathology. Baltimore, Md: Lippincott Williams & Wilkins; 1999:284-5.
Sapp JP, Eversole LR, Wysocki GP. Contemporary Oral and Maxillofacial Pathology. 2nd ed. St. Louis, Mo: Mosby; 2003.
Further Reading
Keywords
pyogenic granuloma, peripheral ossifying fibroma, peripheral giant cell granuloma, pregnancy tumor
