Pyogenic granuloma of the gingiva: A misnomer? – A case report and review of literature
A 22-year-old male reported to the Department of Periodontics, complaining of a swelling in the upper right jaw region, which caused discomfort while eating. The patient reported that he noticed the swelling 2 years ago, which was painless and gradually increased in size, during this period he had visited a medical doctor who had given him gum paint for application. He had stopped brushing the area due to bleeding from the area.\nOn extraoral examination, there was no visible swelling on the right side of the maxilla. Intraoral examination revealed a large sessile lobulated gingival overgrowth extending on buccal surfaces of 15, 16, 17 and 18. It was reddish pink in color with white patches and was approximately 21 mm × 44 mm in size. The surface was smooth no ulcerations were seen and it appeared ovoid in shape []. Buccally it extended beyond the occlusal plane of the teeth giving an appearance of missing teeth []. Oral hygiene was poor and the mouth showed large amounts of calculus. Teeth associated with it did not show any mobility. Radiographically, there were no visible abnormalities and the alveolar bone in the region of the growth appeared normal []. Routine hemogram was found to be normal. A provisional diagnosis of pyogenic granuloma was made. The differential diagnosis included peripheral ossifying fibroma, peripheral giant cell granuloma, hemangioma and fibroma.\nThe patient did not have any systemic problems and so the case was prepared for surgery on the basis of the clinical and radiographic evidence. Oral prophylaxis was completed and the lesion was excised under aseptic conditions. Excision of the lesion up to and including the mucoperiosteum was carried out under local anesthesia using a scalpel and blade, followed by curettage and through scaling of the involved teeth. Periodontal dressing was placed and the patient was recalled after 1 week for removal of the pack and checkup. The excised tissue [] was sent to the Department of Oral Pathology for histologic examination.\nHistopathological report revealed parakeratinized epithelium, stretched in some places and showed proliferation toward the base of the lesion. The underlying connective tissue stroma showed dilated and engorged blood vessels, extravasated red blood cells, angiogenesis, few inflammatory cells and bundles of collagen fibers []. The diagnosis pyogenic granuloma was histologically confirmed.\nThe patient was recalled every 3rd month for maintenance and to check for possible recurrence. This case was followed up for a period of 1 year and there has been no recurrence so far [].