Oral pyogenic granuloma is a reddish-purple non-cancerous oral lesion that is commonly mistaken for a fibroma. Read about its clinical features, causes, and treatment options.
Pyogenic granuloma is a common reactive tumor-like nodular growth seen in the gums caused due to trauma or localized irritation. It is not really a granuloma, as it is not associated with pus and does not have characteristics of a granuloma. It is a result of an inflammatory process, and the growth is composed of blood vessels, connective tissue, and inflammatory cells. It is not a cancerous growth. Pyogenic granuloma can grow anywhere in the mouth but is commonly seen in the gums, lips, tongue, and inside of the cheeks.
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Clinically, it looks similar to peripheral ossifying fibroma and peripheral giant cell granuloma. But the treatment and prognosis of all three conditions are exactly the same.
The clinical features include:
The surface of the growth is usually ulcerated.
It is usually painless.
It is red or purplish in color.
The surface can be smooth or lobulated.
It can be pedunculated (attached to the skin through a stalk) or sessile (attached without a stalk).
The lesion is soft to touch.
It can measure from a few millimeters to centimeters.
New or early lesions are red in color, bleed easily, and are extremely vascular.
Mature lesions are pink and do not bleed easily.
The size of the lesion can grow rapidly.
As they grow, they become fibrous and resemble fibromas.
The difference between oral pyogenic granuloma and peripheral ossifying fibroma or peripheral giant cell granuloma is that the later two lesions occur only in the gingiva and alveolar mucosa. Whereas pyogenic granuloma occurs anywhere in the oral cavity (lips, gums, mucosa).
This growth is the result of irritation or trauma to the gums. The common causes include:
External injury or trauma to the gums.
Poor oral hygiene.
Long-term irritation to the gums from an overhanging restoration or calculus.
Implantitis (inflammation around a dental implant).
Some of the factors that increase the risk of oral pyogenic granuloma, and factors that do not affect are:
There is no racial predilection seen.
Females are more susceptible than males. This is because of the hormonal changes during puberty, pregnancy, and menopause.
Almost 1% of pregnant women get this lesion, so it is also called ‘pregnancy tumor.’
More commonly affects young adults.
Your dentist will diagnose this condition based on clinical features. The dentist will also take radiographs or biopsy to differentiate it from other conditions. The differential diagnoses are:
Peripheral giant-cell granuloma.
Peripheral ossifying fibroma.
Fibroma (benign tumor of fibrous tissue).
Peripheral odontogenic fibroma.
Hemangioma (benign tumor consisting of blood vessels).
Hyperplastic gingival inflammation.
Kaposi’s sarcoma (cancer originating from the lining of blood vessels).
Non-Hodgkin’s lymphoma (cancer originating in the lymphatic system).
Oral pyogenic granuloma had negative radiographic findings. If the lesion is surrounded by calcifications, then it is most probably a peripheral ossifying fibroma.
The lesion is covered by non-keratinized stratified squamous epithelium. If the surface is lobulated, the lesion is composed of proliferating blood vessels. The collagen content is less. Ulcerations can be seen on the surface. Plasma cells, lymphocytes, and neutrophils can also be seen.
Surgical excision of the lesion is the treatment of choice. After excision the lesion, the underlying tissue is scrapped (curettage). The excision extends up to 2 mm from the margins of the lesion and is deep to the periosteum. Causative factors like overhanging restoration, calculus, and foreign body should be removed.
Oral pyogenic granuloma commonly affects pregnant women. More than 1 % of all pregnant women get this lesion. It is best to get this lesion treated after your delivery. If you get it excised during pregnancy, it most often results in recurrence. After childbirth, as the hormones come back to normal, it does not recur.
Some of the ways to prevent this lesion are:
Brush your teeth properly twice a day.
Use a soft bristle brush that does not irritate your gums.
Get scaling and root planing done every 6 months.
If a dental restoration has become loose, get it re-filled.
If any tooth filling impinges on your gums, consult your dentist immediately.
Clean the space between two teeth properly by flossing every day.
With the help of online healthcare platforms, you can now consult experienced doctors online from the comforts of your home. For more information on oral pyogenic granuloma, consult a dentist online.
Oral pyogenic granuloma is always a non-cancerous condition. Some fear that it might be cancer because it resembles the symptoms of malignancy. However, a proper diagnosis is required to confirm the same. Consult with your doctor and get suggestions from them.
Pyogenic granuloma takes about a week for the wound to recover after treatment. In some cases, a pyogenic granuloma may regrow or reappear after the treatment. This disease is most common in pregnant women and children.
Cutting out a pyogenic granuloma is called cauterization. Cauterizing treatment helps to stop the bleeding of pyogenic granuloma. This treatment also reduces the risk of growing it back. But, the surgical method is an effective way to remove the entire growth of pyogenic granuloma. After surgery, the wound is closed using stitches.
Pyogenic granulomas tend to bleed quickly, even with minor swelling. This can lead to the formation of a crust over the top of the skin, and also, they can become a darker red color with time. Pyogenic granulomas may be lumpy on the surface like a raspberry. Pyogenic granulomas remain as it is on the surface and they are not contagious. They cannot spread from a person to another person.
Since pyogenic granuloma is a benign condition, it is mostly removed due to its distressing appearance, tenderness, and the tendency to bleed. However, untreated pyogenic granulomas may go away on their own.
Several techniques used to remove pyogenic granuloma such as:
- Curettage and cauterization.
- Surgical excision.
- Laser surgery.
- Chemical cauterization using silver nitrate is a method followed for removing small lesions.
- Cryotherapy. This is suitable for removing small lesions.
- Imiquimod cream - It has been reported as an effective method and particularly more helpful for children.
- Propranolol ointment. This ointment is not recommended most of the time.
Pyogenic granuloma typically first appears as a blue-black spot, brownish-red, or painless red. It overgrows for a few days to weeks to a final dimension of one to two cm. And occasionally up to five cm in size. Pyogenic granuloma bleeds easily and may lead to ulceration and form a crusted sore.
Pyogenic granuloma can be painful, primarily if located in a region of the body where it is continuously disturbed. Pyogenic granulomas can overgrow and will often bleed extensively with little or no trauma. They may exude an oil-like substance, causing the surface to be damp.
Pyogenic granuloma are characterized by small, firm bumps (papules or nodules) arranged in a ring on the skin. These bumps are usually yellow, slightly red, or skin-colored. In most of the cases, pyogenic granuloma vanishes without any treatments (spontaneous resolution).
If pyogenic granuloma tends to bleed, it may seem like a lot of blood are lost. However, pyogenic granuloma does not lead to blood loss. To stop the bleeding, apply some ointment (like petroleum jelly) on a cold washcloth and apply firm pressure on it for a minimum of ten minutes atleast.
Last reviewed at:
07 Apr 2022 - 4 min read
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