Introduction
Among lesions in the oral cavity consisting of abnormal growths, pyogenic granuloma is the most common, even in children. ‘Pyogenic granuloma’ is a misleading term as they are neither infectious nor granulomatous. The correct name for it would be - lobular capillary hemangioma. This lesion usually occurs in children and young adults as a solitary, shiny red papule or nodule, prone to bleeding and ulceration.
- Name: Azmi
- Age/Gender: 9 yrs/female
- Place of birth: Amroha
- Address: Amroha UP
- Parent’s occupation: Father is a farmer, mother is a housewife.
- Religion: Muslim
- Family income: 4 figures
Case Report
A 9 year old female patient reported to the clinic with a chief complaint of bleeding gums and bad breath since 1-2 months.
The patient was completely asymptomatic 1-2 months back. She noticed a small swelling on the lingual side of her lower anterior region. The swelling gradually increased in size and also developed a tendency to bleed.
Nothing relevant was reported in pre-natal, natal and post natal history.
On extra oral examination, no abnormality was detected in hairline, skin, eyes, nose, ears, lips, nails, lymph nodes and TMJ.
On intra oral examination, a gingival overgrowth was seen irt 73, 74, 75 which was soft in consistency and was bleeding on slight touch. Deep carious lesions were seen in 64. The dentition was mixed dentition, with a Class I molar relationship on both the sides. The overjet and overbite were normal. No abnormality was detected on rest of the soft tissue.
Intra Oral Examination: Mucosa, Palate, Floor of the Mouth, Tongue, Salivary Gland, Lymph Nodes and Buccal Mucosa.
Gingiva: Pale pinkish in color scalloped with round margins
- Teeth present: 16 55 54 53 12 11 21 22 63 64 65 26 36 75 74 73 32 31 41 42 83 84 85 46
- Stains/Calculus: +/+
- Carious 64
- MOLAR RELATIONSHIP: Angle’s Class 1 (on both sides)
- Overjet/Overbite: Normal
Provisional diagnosis was pyogenic granuloma. An orthopantomogram (OPG) was taken.
The differential diagnosis was
- peripheral giant cell granuloma (presence of multinucleated giant cells and lack of an infectious source)
- peripheral ossifying fibroma (minimal vascular component unlike a pyogenic granuloma)
- pregnancy tumour
- Kaposi’s sarcoma (acquired deficiency syndrome)
For the final diagnosis, an excisions biopsy was planned
Provisional diagnosis: Pyogenic Granuloma
Investigation: OPG was done
Differential Diagnosis:
Treatment Plan
For the preparatory phase oral prophylaxis and oral hygiene instructions were given. The patient was sent for minor blood investigations - CBC, CT, BT.
For the corrective phase, surgical excision of the overgrowth and extraction of 64 was done. Patient was kept on a periodic recall and follow up for every 3 months.
Corrective Phase
Extraction of 64 was done. For the surgical excision -
- Intra oral and extra oral scrubbing was done with betadine solution
- Gingival incision was given with scalpel blade
- The gingival tissue was obtained and sent for biopsy
The biopsy result and the final diagnosis was pyogenic granuloma.
Discussion
Pyogenic Granuloma (PG) (also known as "Granuloma gravidarum") is primarily an oral disease which was first described by Hullihen in 1844 and was originally described in 1897 by two French surgeons, Poncet and Dor, who named this lesion as “OtyomycosisHominis.” It is actually not a granuloma but a capillary haemangioma due to which it has the inherent tendency to bleed. This term was introduced by Hartzal in 1904.
The etiology of pyogenic granuloma is generally multifactorial and various factors are responsible for its occurrence. They can be briefly summarized as
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