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 Examination
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 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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Typical appearance of a pyogenic granuloma involving the buccal gingiva of teeth numbers 20 and 21. Note the extreme vascularity.
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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.
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Pyogenic granuloma of the dorsal tongue in a 52-year-old black woman. An area of geographic tongue is adjacent to the pyogenic granuloma.
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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.
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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.
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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.
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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.
