Pyogenic granuloma is a pedunculated hemorrhagic nodule that occurs most frequently on the gingiva and that has a strong tendency to recur after simple excision(Figure 7-4). Chronic irritation as a causative factor for these lesions may sometimes be hard to identify, but the fact that they are usually located close to the gingival margin suggests that calculus,
food materials, and overhanging margins of dental restorations are important irritants that should be eliminated when the lesion is excised. Their friable, hemorrhagic, and frequently ulcerated appearance correlates with their histologic structure. They are comprised of proliferating endothelial tissue, much of which is canalized into a rich vascular network with minimal collagenous support. Polymorphs, as well as chronic inflammatory cells, are consistently present throughout the edematous stroma, with microabscess formation. Despite the common name for the lesion, a frank discharge of pus is not present; when such a discharge occurs, one is probably dealing with a fistula from an underlying periodontal or periapical abscess, the opening of which is often marked by a nodule of granulation tissue.
Identical lesions with the same histologic structure occur in association with the florid gingivitis and periodontitis that may complicate pregnancy.Under these circumstances, the lesions are referred to as pregnancy epulis or pregnancy tumor (see Figure 7-3, C). The increased prevalence of pregnancy epulides toward the end of pregnancy (when levels of circulating estrogens are highest) and the tendency for these lesions to shrink after delivery (when there is a precipitous drop in circulating estrogens) indicate a definite role for these hormones in the etiology of the lesion.Like pregnancy gingivitis, these lesions do not occur in mouths that are kept scrupulously free of even minor gingival irritation, and local irritation is clearly also an important etiologic factor. The relatively minor degree of chronic irritation that may be necessary to produce a pregnancy epulis is noteworthy.
Both pyogenic granulomas and pregnancy epulides may mature and become less vascular and more collagenous, gradually converting to fibrous epulides. Similar lesions also occur intraorally in extragingival locations. Histologically, differentiation from hemangioma is important.A lesion that is closely related to pyogenic granulomas and peripheral giant cell granulomas (see below) is the peripheral ossifying fibroma. This lesion is found exclusively on the gingiva; it does not arise in other oral mucosal locations. Clinically, it varies from pale pink to cherry red and is typically located in the interdental papilla region. This reactive proliferation is so named because of the histologic evidence of calcifications and ossifications that are seen in the context of a hypercellular fibroblastic stroma. Like pyogenic granulomas, peripheral ossifying fibromas are commonly encountered among pregnant women.
The existence of these lesions indicates the need for a periodontal consultation, and treatment should include the elimination of subgingival irritants and gingival “pockets” throughout the mouth, as well as excision of the gingival growth. Small isolated pregnancy tumors occurring in a mouth that is otherwise in excellent gingival health may sometimes be observed for resolution following delivery, but the size of the lesion, episodes of hemorrhage or superimposed acute necrotizing ulcerative gingivitis, and the presence of a generalized pregnancy gingivitis usually dictate treatment during pregnancy. When possible, surgical and periodontal treatment should be completed during the second trimester, with continued surveillance of home care until after delivery.
Identical lesions with the same histologic structure occur in association with the florid gingivitis and periodontitis that may complicate pregnancy.Under these circumstances, the lesions are referred to as pregnancy epulis or pregnancy tumor (see Figure 7-3, C). The increased prevalence of pregnancy epulides toward the end of pregnancy (when levels of circulating estrogens are highest) and the tendency for these lesions to shrink after delivery (when there is a precipitous drop in circulating estrogens) indicate a definite role for these hormones in the etiology of the lesion.Like pregnancy gingivitis, these lesions do not occur in mouths that are kept scrupulously free of even minor gingival irritation, and local irritation is clearly also an important etiologic factor. The relatively minor degree of chronic irritation that may be necessary to produce a pregnancy epulis is noteworthy.
Both pyogenic granulomas and pregnancy epulides may mature and become less vascular and more collagenous, gradually converting to fibrous epulides. Similar lesions also occur intraorally in extragingival locations. Histologically, differentiation from hemangioma is important.A lesion that is closely related to pyogenic granulomas and peripheral giant cell granulomas (see below) is the peripheral ossifying fibroma. This lesion is found exclusively on the gingiva; it does not arise in other oral mucosal locations. Clinically, it varies from pale pink to cherry red and is typically located in the interdental papilla region. This reactive proliferation is so named because of the histologic evidence of calcifications and ossifications that are seen in the context of a hypercellular fibroblastic stroma. Like pyogenic granulomas, peripheral ossifying fibromas are commonly encountered among pregnant women.
The existence of these lesions indicates the need for a periodontal consultation, and treatment should include the elimination of subgingival irritants and gingival “pockets” throughout the mouth, as well as excision of the gingival growth. Small isolated pregnancy tumors occurring in a mouth that is otherwise in excellent gingival health may sometimes be observed for resolution following delivery, but the size of the lesion, episodes of hemorrhage or superimposed acute necrotizing ulcerative gingivitis, and the presence of a generalized pregnancy gingivitis usually dictate treatment during pregnancy. When possible, surgical and periodontal treatment should be completed during the second trimester, with continued surveillance of home care until after delivery.