Pyogenic granuloma is a tissue response to non-specific infections. It occurs most commonly as a mouthlesion which appears due to an overgrowth of tissue caused by irritation, trauma or hormonal imbalance. It is a relatively common soft tissue tumor of skin, nasal septum and mucous membrane. The condition is known to be a reactive inflammatory process in which there is an exuberant fibro vascular proliferation of the connective tissue. Pyogenic granuloma is also called as granuloma pyogenicum, eruptive hemangioma and pregnancy tumor.
The typical lesion of pyogenic granuloma is an elevated, pedunculated tumor like growth. It often has a smooth or wart-like surface .The lesion tends to ulcerate and have a very high tendency towards bleeding. In certain lesions bleeding is provoked on slightest pressure application. Exudation and purulent material discharge may also be seen in secondarily infected lesions.
The color of the lesion varies from deep red to reddish purple depending on the blood supply of the lesion. It is usually painless and moderately soft in consistency. Average size of pyogenic granuloma is 0.9 to 1.2 cm in diameter. The lesion rapidly increases to attain the full size and remains static for indefinite period. It may become mature and more collagenous and less vascular converting in to a fibrous epulis.
The common sites for development of pyogenic granuloma are the gums, lip, tongue, cheek mucosa and palate.
Pyogenic granuloma generally affects the age group of 10 to 40 years of age. The condition has a high female predilection and occurs more commonly during pregnancy. The causes are multiple ranging form bacterial infections to low grade irritation.
- Bacterial cause is usually due to botrymycotic infections. Staphylococci and streptococci are also responsible for development of pyogenic granuloma.
- Pyogenic granuloma is also a result of minor trauma to the tissue. The traumatic injury to the tissue provides pathway for invasion for the non-specific microorganisms into the tissue.
- Poor oral hygiene causes accumulation of dental plaque over the teeth surface. Over a period of time this plaque becomes calcified and harbors bacteria. The calcified plaque acts as a low grade stimulant and causes tissue irritation. Pyogenic granuloma can develop as a local inflammatory response in such conditions.
- In females, hormonal imbalance is a contributing factor in developing pyogenic granulomas.
Very small lesions of pyogenic granuloma may not require clinical intervention and heal on its own. However, the high tendency for bleeding and recurrence makes it difficult to treat. Oral hygiene maintenance and periodontal therapy including scaling is essential in treating granuloma caused due to poor oral hygiene. The other causes such as repeated trauma should also be removed.
Certain periodontal surgeries can be undertaken in cases which have recurring tendencies. Surgical excision and care is taken to remove the calculus of adjacent teeth as it may act as a local irritant and cause recurrence. Lesions which are larger in size need surgical excision or cauterization. Lesions posing aesthetic problems also require surgery. Surgical procedures are generally conservative in nature and can be carried out under local anesthesia.