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Oral Pyogenic Granuloma

Background

The pyogenic granuloma is a relatively common, tumorlike, exuberant tissue response to localized irritation or trauma. The name pyogenic granuloma is a misnomer since the condition is not associated with pus and does not represent a granuloma histologically. It is a reactive inflammatory process filled with proliferating vascular channels, immature fibroblastic connective tissue, and scattered inflammatory cells. The surface usually is ulcerated, and the lesion exhibits a lobular architecture. Note the image below.

Typical appearance of a pyogenic granuloma involvi

Typical appearance of a pyogenic granuloma involving the buccal gingiva of teeth numbers 20 and 21. Note the extreme vascularity.

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Two lesions, peripheral ossifying fibroma and peripheral giant cell granuloma, are clinically identical to the pyogenic granuloma when they occur on the gingiva. If 100 biopsies of pyogenic granuloma–appearing lesions of the gingiva are submitted for histologic examination, approximately 75% will be pyogenic granulomas, 20% will be peripheral ossifying fibromas, and 5% will be peripheral giant cell granulomas. The pyogenic granuloma can occur anywhere in the oral cavity, whereas the peripheral ossifying fibroma and peripheral giant cell granuloma only occur on the gingiva or alveolar mucosa. The clinical appearance, treatment, and prognosis are the same for all 3 entities.

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