The patient also reported evolution in location i.e. the growth enlarged from the palatal to facial side interdentally and caused an increase in the space between the left maxillary lateral incisor and canine. He described that by the time of presentation the size of the growth interfered with these functions and was causing changes in his bite. He reported a gradual increase in the size of the growth, which with time led to discomfort during eating and talking. The patient had noticed a small painless growth on the palatal gingiva that began about 11 months ago. Case PresentationĪ 40-year-old systemically healthy male patient presented to the comprehensive care clinic at Penn Dental Medicine for the evaluation of an intraoral growth in the mouth involving the upper left anterior gingiva. To add evidence of the clinical variation in PG, this article describes an unusual case report of a 40-year-old male with an abnormally large pyogenic granuloma extending from the labial to the palatal side of the upper left anterior gingiva that was associated with occlusal trauma and significant alveolar bone loss mimicking malignancy, which was managed by surgical excision. While the existence of PG is well documented in the literature, published cases tend to adhere to the above common presentations, with abnormal manifestations rarely detailed.

As lesions mature, the vascularity decreases, and the clinical appearance becomes thickened, dense and pink in color. The color of the lesion ranges from pink to red to purple with newer, more vascular lesions presenting with deeper visible pigmentation. Lesions are usually hemorrhagic, often abundantly. The lesion is often asymptomatic, painless, and develops slowly, although rapid growth can occur in some cases. Clinically, PG appears as a uniform, lobulated, exophytic growth with a pedunculated or sessile base. Pyogenic granuloma can also affect the lips, mucosa, tongue, and other areas, but is seen rarely in these locations. A further 75% of PG lesions are seen on the gingiva. The most common triggering factor is poor oral hygiene with 75% of all cases showing tartar deposits or foreign substances in the associated gingival crevice. Additionally, on histopathology, PG represents connective tissue enlargement rather than the formation of a granuloma.

While the term 'pyogenic granuloma' would suggest a granular cell reaction associated with pus formation, it is, in fact, a lesion that is reactive and spurred by systemic (hormonal changes) or local (poor oral hygiene, broken teeth, uneven dental fillings, and impacted or retained foreign materials) irritants. It is predominant in females during the second decade of life with a female to male ratio of 2:1. Pyogenic granuloma is nonneoplastic reactive hyperplasia that develops in the context of various local and systemic factors. Inflammatory hyperplasia is an umbrella term that describes reactive oral mucosa consisting of enlarged fibrous and granulation tissues, including pyogenic granuloma (PG).

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