oral Pyogenic Granuloma

pyogenic granuloma

Oral pyogenic granuloma is a common benign (non-cancerous) tumor of blood vessels. It’s the reaction of the oral tissues to certain irritants. It preferentially affects gums in the mouth in 75% of the cases but can also affect lips, hands, and nails. 

It is also known as angiogranuloma (angio means blood, and granuloma is a benign growth).  

Causes of oral pyogenic granuloma

In most cases, it arises spontaneously, at the sites of injury, or within malformed or distorted capillaries. It also occurs due to gene mutation, hormonal fluctuation, or after viral infection (herpes virus type 1 or human papilloma virus type 2).

Moreover, certain medications can trigger its formation as a side effect. If you are taking one or more of the following medications, you can get pyogenic granuloma:

The presence of one or more of the above factors triggers excessive production of tiny blood vessels (capillaries) in the affected tissue or organ. 

Have an open disscussion with your doctor/dentist: Your doctor may inquire about your medical, dental,or drug history, and history of trauma at the affected site to reach the diagnosis. Your answers will help him/her to reach the correct diagnosis.

Demographics of oral pyogenic granuloma

The pyogenic granuloma may occur at any age. However, it is more common in young female adults, possibly because of the fluctuations in female hormones.

Signs and symptoms of oral pyogenic granuloma

The pyogenic granuloma emerges as a single, reddish, or bluish smooth-surfaced mass on the gums. The soft vascular mass may become an ulcer as result of trauma. However, non-ulcerated large swellings resemble a mushroom (smooth and single) or a bunch of grapes (lobulated).

This mass contains distorted blood vessels and tends to bleed profusely. Bleeding from the mass often brings these patient’s to the doctor’s office.

During pregnancy, the pyogenic granuloma shows a significant increase in size under the hormonal influence. This swelling is refered to as pregnancy epulis or tumor. Typically, it snowballs within the first few weeks.

Treatment of pyogenic granuloma

Generally, a pyogenic granuloma isn’t a self-limiting condition and requires treatment. However, a pregnancy epilus frequently shrinks and heals after delivery without treatment. Although it is a benign (non-cancerous) swelling, it’s a nuisance to the patient because of frequent bleeding and cosmetic issues.

Drug-induced pyogenic granulomas often subside or reduce in size once the offending drug is discontinued.

The following are the treatment options depending on the size and accessibility of the tumor:

Surgery

Surgical removal is considered the best treatment for pyogenic granulomas because of the lowest recurrence rate after the treatment. However, the rate of recurrence is higher in pregnancy epilus.

The surgery involves deep dissection of the tissues to remove all the unhealthy tissue that could lead to tumor recurrence. The wound is closed with sutures (stitches) to avoid any infection.

Surgical curettage

Surgical curettage involves surgical scraping of the nodule from its base with a shave or curette followed by cauterization to stop the bleeding. Curettage requires 1-2 treatment sessions to accomplish complete removal. However, the growth reappears in 10% of the cases and the wound heals with some scars. 

Lasers

Lasers such as CO2 laser or pulsed dye laser work best for small growths (average diameter 4mm) and require 1-6 sessions for complete removal.

Cryosurgery

Cryosurgery involves using extreme cold to freeze and remove the abnormal growth. It successfully treats 1.5cm or smaller nodules in 1-3 sessions. 

Sclerotherapy

Sclerotherapy involves injecting a sclerosing solution (monoethanolamine) oleate directly into the vein. The solution causes the vein to scar, forcing blood to reroute through healthier veins. The collapsed vein is reabsorbed into local tissue and eventually fades.

Some patients complain of pain at the injection site, but the lesion heals without scaring and never reappears.

Tablets and creams

Gels, creams, or tablets of timolol or propranolol are given to children. This treatment warrants monitoring and could be taken after professional consultation. Since the cream/gel absorbs in the blood and can lower blood pressure, pulse rate, blood sugar level, and narrow airways, so the dosage needs monitoring.

Complications of pyogenic granuloma 

The Pyogenic Granuloma can lead to one or more of the following complications:

  • The most common complication associated with pyogenic granuloma is bleeding and ulceration that can lead to secondary bacterial, or fungal infections.
  • The growth tends to recur if small tumor fragments are left behind during its removal. 
  • After the treatment, multiple small tumors may arise in the region, called satellite nodules of pyogenic Granuloma.
  • Unpleasant physical appearance due to swelling shatters the individual’s confidence, and self-esteem and they frequently suffer from social isolation and depression.

Summary 

Pyogenic granuloma is a common benign tumor of blood vessels. It preferentially affects the gums in the mouth but also affects lips, hands and nails. 

It occurs spontaneously after a trauma, viral infection or genetic mutation. Some medications are also thought to play a role in its development. It commonly affects young female adults who are on oral contraceptives. 

Surgical removal is regarded as the best treatment for pyogenic granuloma with negligible chances of recurrence. Other alternatives are curettage, cryosurgery, laser, sclerotherapy, tablets and creams. 

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