Pyogenic granuloma on the gingiva of anterior teeth. Case by @pnwoms. This is a long-standing lesion that has gotten fibrosed and less vascular which can be indicated by its pink coloration.The pyogenic granuloma is a relatively common, tumorlike, exuberant tissue response to localized irritation or trauma. The name pyogenic granuloma is a misnomer since the condition is not associated with pus and does not represent a granuloma histologically. It is a reactive inflammatory process filled with proliferating vascular channels, immature fibroblastic connective tissue, and scattered inflammatory cells. The surface usually is ulcerated, and the lesion exhibits a lobular architecture. Early lesions bleed easily due to extreme vascularity. The typical lesion involves the interproximal gingiva and increases in size to cover a portion of the adjacent teeth. The maxillary gingiva (especially in the anterior region) is involved more frequently than the mandibular gingiva; the facial gingiva is involved more than the lingual gingiva. Pyogenic granulomas usually present as smooth or lobulated red-to-purple masses that may be either pedunculated or sessile. As lesions mature, the vascularity decreases and the clinical appearance is more collagenous and pink. Pyogenic granulomas vary in size from a few millimeters to several centimeters and are painless. These tumors are soft to palpation. A history of trauma is common in extragingival sites, whereas most lesions of the gingiva are a response to irritation. Individuals with poor oral hygiene and chronic oral irritants (eg, overhanging restorations, calculus) most frequently are affected.
The treatment of choice is conservative surgical excision. For gingival lesions, excising the lesion down to the periosteum and scaling adjacent teeth to remove any calculus and plaque that may be a source of continuing irritation is recommended. Pyogenic granuloma occasionally recurs, and a re-excision is necessary. The recurrence rate is higher for pyogenic granulomas removed during pregnancy.