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International Journal o f Gynecology & Obstetrics 49 (1995) 331-332

Letter to the editorOral pyogenic granuloma in pregnancy

L.H. Silverstein*, C.H. Burton Jr.b, B.B. SinghcaDepartment of Periodontology. School of Dentistry, Medical College of Georgia, Augusta, GA, USAbAtlanta, GA, USA

Department of Oral Pathology, Medical College of Georgia, Augusta, GA, USAReceived 22 December 1994 ; revision received 1 February 1995:accepted 21 February 1995

Keywords: Pyogenic granuloma; Pregnancy tumor; Pregnancy granuloma; Granuloma gravidarum

An oral pyogenic granuloma can developimmediately following the first trimester of preg-nancy. Usually an oral pyogenic granuloma is aslow-growing mass that does not, upon excision,leave a large defect in the periodontium requiringsurgical repair. However an oral pyogenicgranuloma often grows into a large mass in thegravid female, which generally emanates from astalk, originating at an interdental gingival papilla(Fig. 1). Although such lesions are commonlyknown as pregnancy tumors or pregnancyepulides, they are clinically and histologicallyindistinguishable from an oral pyogenic granu-loma occurring in males and in non-pregnantfemales (Fig. 2) [l]. Pyogenic granulomata, onboth skin and mucous surfaces,are usually benignfibrovascular proliferations which should beregarded as inflammatory overgrowths and nottrue neoplasms [2].

* Corresponding author, Kennestone Periodontics, 1950North Park Place, Suite 400, Atlanta, GA 30339,USA, Tel.: +I404 9525432; Fax: +I 404 952301 .

Oral pyogenic granuloma of pregnancy, likepregnancy gingivitis, is merely an exaggeratedresponse o local existing irritants brought aboutby elevated levels of sex hormones. Morespecifically, gingival inflammation increases

Fig. I. Pyogenic granuloma, so-called pregnancy tumor, ofmandibular labial gingiva, usually erythematous and not re-lated to pulp disease.This lesion exhibited a lobulated surfacewith a white-yellowish membrane.0020-7292/95/ 09.50 0 1995 nternational Federation of Gynecology and ObstetricsSSDI 0020-7292(95)02379-Q

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332 L.H. Silverstein et al. /International Journal of Gynecology & Obstetrics 49 (1995) 331-332

Fig. 2. Photomicrograph showing areas of edema within thecellular constituent fibrous connective tissue of this large lesionjust beneath the hyperparatotic acanthotic edematousstratifiedsquamous epithelium (H&E x 40).

significantly during pregnancy becauseof elevatedlevels of circulating hormones. The severity ofgingival inflammation appears to follow moreclosely the levels of circulating estrogen and pro-gesterone [3].During pregnancy, intraorally, the interpr-oximal gingival tissues seem o be most involvedwith inflammatory changes as well as increases nboth tooth mobility and probing pocket depths.These inflammatory gingival changes are usuallyseen at the end of the first trimester but candevelop very late and rapidly in the third trimester.Thus the importance of oral hygiene, especially inpregnant and pseudo-pregnant women, cannot be

overemphasized. t is also important to be awarethat these lesions can become arge and result inseveredestruction of the periodontium which maynecessitate urgical repair of the gingival and alve-olar tissues utilizing periodontal plastic surgerytechniques.These lesions can be treated successfully withscaling under local anesthesia during pregnancyfollowing consultation with the primary carephysician. It seems o be the opinion of manyobstetricians, as reported by Tarsitano and Roll-ings [4], that since these lesions are not life-threatening emergencies, treatment should bedelayed until after delivery to decrease thepossibility of causing a preterm delivery. If,following birth, these lesions are large and fail toregress, then the treatment of choice would besurgical excision.In summation, both medical and dental clini-cians should be aware that an oral pyogenicgranuloma can develop very late duringpregnancy.References[I] Hugoson A. Gingival inflammation and female sex hor-mones. J Periodontol Res 1970; 5 Suppl 5: 9.[2] Daley TD, Wysocki GP, Wysocki PD, Wysocki DM. Themajor epulides: clinicopathological correlations. J CanDent Assoc 1990; 56: 627-630.[3] Guyton AC. Human physiology and mechanisms ofdisease.4th ed. Philadelphia, PA: Saunders, 1987.[4] Tarsitano BF, Rollings RE. The pregnant dental patient:evaluation and management. Gen Dentist J 1993;41(3):226-231.