PYOGENIC GRANULOMA

“It is a hemorrhagic nodule”

Site:  Gingiva (most common), can be found on any surface

Cause: Chronic irritation – calculus, food materials, overhanging restoration

Clinical features:

• Hemorrhagic, friable, and frequently ulcerated
• Pus is not present – if present, it may be a sinus tract due to underlying periodontal or periapical abscess. The opening of this tract is covered by a nodule of granulation tissue called “parulis”

Histological features:

• Proliferating endothelial cells which are canalized into a rich vascular network with minimal collagenous support.
• Neutrophils and chronic inflammatory cells

Differential diagnosis:

• Hemangioma – differentiated histologically
• In association with Florid gingivitis and periodontitis that complicate pregnancy (same clinical and histological features)– occur at the end of pregnancy when circulating estrogens are high and shrink after delivery.
• Pyogenic ranulomas and pregnancy epulides – mature—less vascularised + more collagenous—fibrous epulides.

Treatment: Lesion to be excised and local irritants eliminated.

Prognosis:  Tendency to recur if irritant is not removed.