Oral Pyogenic Granuloma - Causes, Risk Factors, Diagnosis, Treatment, and Prevention

What Is Oral Pyogenic Granuloma?

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.

How Does an Oral Pyogenic Granuloma Look?

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).

What Are the Causes of Oral Pyogenic Granuloma?

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.

• Hormonal imbalance.

• Implantitis (inflammation around a dental implant).

What Are the Risk Factors for Oral Pyogenic Granuloma?

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.

How Is an Oral Pyogenic Granuloma Diagnosed?

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:

1. Peripheral giant-cell granuloma.

2. Peripheral ossifying fibroma.

3. Fibroma (benign tumor of fibrous tissue).

4. Peripheral odontogenic fibroma.

5. Hemangioma (benign tumor consisting of blood vessels).

6. Hyperplastic gingival inflammation.

7. Kaposi’s sarcoma (cancer originating from the lining of blood vessels).

8. Angiosarcoma.

9. Non-Hodgkin’s lymphoma (cancer originating in the lymphatic system).

Radiographic Features:

Oral pyogenic granuloma had negative radiographic findings. If the lesion is surrounded by calcifications, then it is most probably a peripheral ossifying fibroma.

Histopathologic (Microscopic) Feature:

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.

How Is an Oral Pyogenic Granuloma Treated?

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.

Pregnancy Tumor:

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.

Can Oral Pyogenic Granuloma Be Prevented?

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.