Introduction: Pyogenic granuloma is one of the inflammatory hyperplasias seen in the oral cavity. It arises in response to various stimuli, such as low grade local irritation, traumatic injury, sex hormones, and certain kinds of drugs such as cyclosporine. Clinically, oral pyogenic granuloma is a smooth or lobulated exophytic lesion manifesting as small, red erythematous papule on a pedunculate or sometimes sessile base, which is usually haemorrhagic and compressible. Oral pyogenic granuloma shows a striking predilection for the gingiva, followed by lips, tongue, and buccal mucosa. Lesions are more common on the maxillary gingiva than the mandibular gingiva.
Objective: To prevent the recurrence of pyogenic granuloma.
Methodology: A 42-year-old female patient reported to our department of periodontology in PGIDS Rohtak, with a chief complaint of swelling in the upper front teeth which bleeds during tooth brushing and on slight provocation. The patient gave a history of treatment of this lesion in a private clinical setting twice 6 months ago. Clinical examination revealed a smooth, red, painless erythematous swelling on the interdental papilla between maxillary central incisors extending to involve palatal side. Differential diagnosis of pyogenic granuloma was made. Excisional biopsy was then performed under LA to remove the lesion; open flap debridement was carried out in relation to maxillary central incisors, and tissue was sent for histopathologic examination. Postoperative instructions were given and the patient recalled for suture removal after a week.
Result: The histopathologic report confirmed the diagnosis of pyogenic granuloma. The lesion was completely resolved and followed up for 6 months.
Discussion and conclusion: Excisional surgery is the treatment of choice for this condition; other treatment protocols such as the use of Nd:YAG laser, cryosurgery, intralesional injection of corticosteroids and sodium tetradecyl sulfate sclerotherapy have been proposed. To prevent the recurrence of pyogenic granuloma, excisional biopsy along with open flap debridement should be carried out to remove granulation tissue and subgingival deposits. Private practitioners should emphasise the need of complete debridement to remove local irritant factors present subgingivally.
Keywords: granuloma, hyperplasia, periodontitis
