International Journal of Contemporary Pediatrics

Gera D et al. Int J Contemp Pediatr. 2023 Apr;10(4):607-610

http://www.ijpediatrics.com pISSN 2349-3283 | eISSN 2349-3291

DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20230749
Case Report

Pyogenic granuloma in a 6-year-old boy - a rare case report

Divya Gera1*, Anshul Tanwar2, Anant G. Nigam1, Shradha Jain1, Vipul Sharma1

1
Department of Pediatric and Preventive Dentistry, 2Department of Periodontology, Mahatma Gandhi Dental College
and Hospital, Jaipur, Rajasthan, India

Received: 09 February 2023

Revised: 07 March 2023
Accepted: 10 March 2023

*Correspondence:
Dr. Divya Gera,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

The gingiva, also known as the gums, is the pink-coloured keratinized mucosa that surrounds and protects the teeth.
Gingival enlargement or gingival overgrowth, a common trait of gingival disease, is characterized by an increase in the
size of gingiva. Irritation fibroma is an exophytic soft tissue mass in the oral mucosa. Indeed, it is not a real neoplasm,
but a focal hyperplasia of fibrous connective tissue induced by local trauma or chronic irritation. Pyogenic granuloma
is one of the inflammatory hyperplasia seen in the oral cavity, majority are found on the marginal gingiva with only
15% of the tumours on the alveolar part. It predominantly occurs in the second decade of life in young females, male
to female ratio is 1:99, and size of lesion varies in diameter from few millimetres to several centimetres. This article
presents a case of pyogenic granuloma in an 6year old boy who presented with a gingival overgrowth in his mandibular
left buccal surface region i.r.t 31 including marginal and attached gingiva. He had discomfort during mastication,
interferes with occlusion there was episode of bleeding during brushing. The lesion was excised and histopathological
report confirmed the diagnosis. Case was followed up for six months and no recurrence of the lesion. Etiological factors,
clinical features, differential diagnosis and different treatment options are discussed based on the review of current
literature available.

Keywords: Mandibular, Pyogenic granuloma, Anterior teeth, Reactive hyperplasia, Trauma

INTRODUCTION hyperplasia of fibrous connective tissue induced by local

trauma or chronic irritation.3
The gingiva, also known as the gums, is the pink-coloured
keratinized mucosa that surrounds and protects the teeth. Pyogenic granuloma (PG) is prudently common, tumor
It is perfused by multiple small arteries that originate from like growth in the oral cavity. It is neither granulomatous
branches coming off the carotid artery. It receives nor contains pus, hence the name is a misnomer.4,5 In 1897,
innervation by nerves derived from the mandibular and two French Surgeons Poncet and Dor initially named this
maxillary divisions of the trigeminal nerve.1 Gingival lesion as a Botryomycosis hominis.6 Hartzell in 1904
enlargement or gingival overgrowth, a common trait of introduced term PG or Granuloma Pyogenicum. Other
gingival disease, is characterized by an increase in the size name given to this is Crocker and Hartzell’s disease.4
of gingiva.2 Histologically described it as a haemangiomatous
granuloma” due to the occurrence of abundant blood
Irritation fibroma is an exophytic soft tissue mass in the vessels and the inflammatory nature of the lesion. Other
oral mucosa. Indeed, it is not a real neoplasm, but a focal name used for this lesion is Granuloma
telangiectacticum.6

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Based on the vascularity of the lesion color can be different

from red to pink. More than alveolar mucosa, marginal
gingival is prevalent. Apart from the gingiva, PG can occur
on the buccal mucosa, lips, tongue and palate. Maxilla is
more commonly affected than mandible.7

Buccal surface of the posterior teeth are more common

rather than lingual surfaces anterior teeth. Initially, the
lesion starts with a small growth, growing slowly from a
few millimetres to centimetres and it remains
asymptomatic and painless unless there is an infection.
Occasionally, the size of the lesion increases rapidly.7 Figure 2: Intra oral pictures showing the pocket depth
assessment of the lesion.
The lesion starts with small, exophytic growth, has a
smooth or lobulated surface, erythematous papule, red in
colour and can have pedunculated or sometimes sessile
base. Only 15% of the lesions occur on the alveolar part
but majority of them establish on the marginal gingiva and
at times it causes significant bone loss.8 Although PG can
occur in all the ages, it is predominant in the second decade
of life, females are more commonly affected than males
due to hormonal changes.9

CASE REPORT

A 6-year-old boy complaint of overgrowth of gums in

mouth pertaining to lower front tooth region since 10 days, Figure 3: Intraoral picture showing uneventful
which bled frequently and interfered with eating and healing of the lesion.
brushing. His mother noticed the growth 10 days back and
it was gradually increasing since then. There was no
evident family and medical history. On extraoral
examination no abnormality was detected. Intraoral
examination revealed single growing exophytic, lesion
which was pedunculated with stalk, measuring 0.5×1×0.8
cm in the lower anterior region. It was attached to the
marginal and attached gingiva i.r.t 31 (Figure 1). It was
oval in shape, had a smooth surface, reddish in colour,
pedunculated, bled on probing and covered buccal surface
of the teeth (Figure 2). These findings were confirmed by
palpation of the lesion. In personal oral habits, parents
gave history of nail biting i.r.t the affected site.
Furthermore, there was presence of mobility in the
involved tooth. Oral hygiene status seemed to be average. Figure 4: Histopathological impression of the excised
Blood picture showed all the values within the normal lesion.
range.
Based on the history and intra oral findings, provisionally
it was diagnosed it as irritational fibroma. The differential
diagnosis can be given as fibroma, haemangioma,
peripheral ossifying fibroma and peripheral giant cell
granuloma.

The treatment plan in this case was excision of the lesion

and treatment was explained to the parents. The lesion was
excised surgically using electrocautery and normal saline
was used to irrigate the surgical site. Post-operative
instructions were given, medication was prescribed, and
excised lesion was sent for histopathological examination.

Figure 1: Intra oral pictures showing the lesion of the After two weeks, patient came for follow up and the
mandible. healing site was satisfactory. Furthermore, patient was on

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 Gera D et al. Int J Contemp Pediatr. 2023 Apr;10(4):607-610

regular follow up for six months and there were no signs CONCLUSION
of recurrence (Figure 3).
Benign lesions like pyogenic granuloma at times may
Histopathological examination and impression grow rapidly in size which disturbs the day-to-day
activities by causing pain and discomfort to the patient
Macroscopic features especially in children. It also interferes in maintaining oral
hygiene which in turn complicates the situation. Hence
Received a small piece of soft tissue, measuring about early diagnosis and prompt treatment is very important to
0.5×1×0.8 cm, reddish brown in colour, irregular in shape, prevent further complications. Dentists should have well
lobulated in contour and firm in consistency. Section informed knowledge regarding these types of lesions and
shows thin proliferating para keratinized stratified it should first come into the knowledge of the pediatric
squamous epithelium with long rete ridges. The underlying dentist as early as possible to prevent discomfort as well as
connective tissue shows numerous enlarged capillaries to improve quality of life of the children.
with endothelial cells, proliferation, severe chronic
inflammatory cells infiltrates and extravasated RBCs. Funding: No funding sources
Based on the histological features diagnosis was Conflict of interest: None declared
confirmed as a pyogenic granuloma (Figure 4). Ethical approval: Not required

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