granuloma gravidarum ( gg ) is an inflammatory lesion , which develops in the oral mucosa 
 of pregnant women in response to chronic irritants of low degree such as bacterial 
 biofilm , dental calculus and traumatic agents . increased concentrations of estrogen and 
 progesterone raises the levels of prevotella intermedia in the subgingival 
 biofilm , diminishes the host response to bacterial biofilm , increases vascular permeability , 
 favors the infiltration of fluids into the perivascular tissues and enhances the 
 inflammatory response , having an important role in the development of the lesion . from the histopathological point of view there is a variation in the nomenclature of lesions based on their 
 occurrence in the gestation period . the lesions are composed of highly 
 proliferative vascular tissue , with numerous channels bordered by endothelium , which can 
 appear obliterated by erythrocytes . the need for surgical intervention during pregnancy should be carefully 
 examined , considering the high rate of gg recurrence , as well as the possibility of 
 regression after childbirth , due to the normalization of hormonal levels . in general , treatment during pregnancy is 
 necessary if the lesion causes functional or aesthetic harm . on the other hand , the 
 control of the bacterial biofilm is of great importance to prevent recurrence after 
 treatment . the aim of this study was to characterize gg , by means of an epidemiological survey of cases 
 diagnosed over a period of 32 years , in the oral medicine division , so lucas hospital- 
 pontifical catholic university of rio grande do sul ( pucrs ) , brazil . a total of 206 medical records of female patients with pyogenic granuloma , diagnosed 
 from 1980 to 2012 , were selected in the oral medicine division , so lucas hospital - 
 pontifical catholic university of rio grande do sul ( pucrs ) , brazil . the cases were reviewed 
 to determine if the lesion developed during pregnancy , which characterizes gg . the 
 histological slides were reviewed by a pathologist to confirm the anatomopathological 
 diagnosis . the following information was obtained from the selected medical records : age of 
 patients , location , size , coloration and type of lesion insertion , as well as the presence 
 of ulceration , bleeding and local irritants ( bacterial biofilm , dental calculus , gingivitis 
 ortrauma ) . the gestation period in which the lesion occurred , comparison of the results for age groups , gestation period and lesion size was carried 
 out by constructing contingency tables and applying the chi - square test . due to the small 
 sample size , the significance of the test was obtained via simulation using the monte 
 carlo method . comparison of the results for age groups , gestation period and lesion size was carried 
 out by constructing contingency tables and applying the chi - square test . due to the small 
 sample size , the significance of the test was obtained via simulation using the monte 
 carlo method . forty - one cases of gg were found in patients aged 19 to 44 years , with a mean of 28 
 years(sd 6.45 ) . in 51.22% of the cases , the lesion had developed in the third trimester 
 of pregnancy , in 24.39% in the second trimester and in 17.07% in the first trimester . the most prevalent location of gg was the gingiva , corresponding to 73.17% of the 
 cases , with no statistically significant difference between the upper and lower region . the 
 other affected sites were the tongue ( 14.63% ) , lip ( 7.32% ) , palate and buccal mucosa ( 4.88% ) . the lesions appeared as nodules with diameters of 0.5 to 3.5 cm with a mean of 1.46 
 cm ( sd0.89 ) . reddish coloration was observed in 92.68% of the cases , an ulcerated surface 
 was present in 31.71% , and the occurrence of bleeding , spontaneous or upon touch , occurred 
 in 48.78% of the gg cases . pedunculated base was observed in 60.98% of the cases , while in 
 the other cases , the lesions were sessile ( figures 1 
 and 2 ) . gg on lip associated with trauma by orthodontic appliance gg with ulceration in gingiva the mean time of development was 168 days , but most lesions ( 65.85% ) had up to 3 months 
 of duration . the 
 irritants described in the medical records were bacterial biofilm ( 29.27% ) , gingivitis 
 ( 21.95% ) , calculus ( 12.20% ) and trauma ( 12.20% ) . age of patients with gg , localization , clinical characteristics of lesions , 
 predisposing factors and gestation period when lesions developed regarding treatment , 82.93% of the lesions were surgically excised . in 41.18% of the 
 cases , the excision was performed a few weeks or months after childbirth and in 58.82% of 
 the cases , it was performed during pregnancy . after the removal of local irritants , 
 three lesions ( 7.32% ) had spontaneous remission , two of them during pregnancy . in 9.75% of 
 the cases , there was a significant association between age and gestation period since the 
 pregnant women up to 25 years old showed a tendency to develop gg in the first trimester of 
 pregnancy ( 50% , p=0.057 ) . the patients with ages between 26 and 35 years showed the lesion 
 mainly in the third trimester ( 78.9% p=0.001 ) . there are various retrospective studies that have reported on the 
 clinicopathological characteristics of pyogenic granuloma , among which cases of gg are often 
 included . however , a series of cases specifically examining the clinical characteristics of 
 gg are not found in the literature . thus , the present study aimed to retrospectively review 
 41 cases of gg diagnosed in the oral medicine division , so lucas hospital , brazil . gg can start developing during the first trimester of pregnancy and its incidence 
 increases as of the seventh month . these characteristics were demonstrated in the present study , in which the pregnant women up 
 to 25 years old showed a tendency to develop the lesion in the first trimester , but the 
 majority of lesions occurred in the third trimester . the lesions were more prevalent in the 
 third decade of life , where the mean age of the patients was 28 years . this is the first study to date to 
 specifically describe the age of patients with gg .   in the present study , 73.17% of the lesions were located in the gingiva , without 
 a difference between the upper or lower region . according to the literature , the gingiva 
 is the most affected region , and the upper lesions are more prevalent . the presence of some predisposing factor was 
 detected in 75.61% of the cases studied . bacterial biofilm and dental calculus were the main 
 local irritants associated with gg , explaining the greater involvement of the gingiva 
 by inflammatory lesions . other sites such as the tongue , lip , palate and buccal mucosa can 
 be affected due to traumatic factors . thus , the presence of local irritants associated 
 with hormonal factors increases the probability of the development of gg , mainly in the 
 gingiva . during pregnancy , marked inflammatory characteristics are usually observed in the 
 gingiva , with the presence of edema , intense erythema , hyperplasia and an increased tendency 
 of bleeding . this is due to the 
 capacity of pregnant women to produce large amounts of progesterone and estrogen , which 
 potentiate the vascular response .   despite of the possibility of regression of gg with the regularization of hormone 
 levels after childbirth , in 58.82% of 
 the cases surgery was an option of the patients due to the aesthetic harm , bleeding and 
 halitosis caused by the lesions . moreover , in 41.18% of the cases , even after childbirth , 
 there was no remission and the lesions were also surgically treated .   in this study , the lesions were clinically observed as pedunculated or sessile 
 nodules , usually reddish color , capable or not of bleeding and ulceration . these findings 
 are compatible with those described in the international literature with respect to the 
 clinical appearance of pyogenic granuloma , and therefore demonstrate that there are 
 no clinical differences between the two lesions . these alterations can have repercussions on the oral cavity , predisposing the pregnant woman 
 to periodontal inflammation , where gg is a reactional lesion resulting from this 
 inflammation . the hormonal conditions of pregnancy can have an impact on the oral cavity , predisposing the 
 patient to inflammatory lesions such as gg .
granuloma gravidarum ( gg ) is an inflammatory lesion , which develops in the oral mucosa of 
 pregnant women in response to chronic low - grade irritants , under the influence of hormonal 
 factors.objective:to characterize gg clinically by means of a retrospective study of the cases of the 
 oral medicine division , so lucas hospital , brazil.material and methods : cases of gg diagnosed between 1980 and 2012 were analyzed . 
 data were obtained 
 referring to the age of the patients , lesion location , clinical features , as well as the 
 presence of local irritants . 
 the gestation period in which the lesion developed was also 
 investigated . 
 results : forty - one cases of gg were found . 
 the lesions developed predominantly in the third 
 trimester of pregnancy ( 51.22% ) and the mean age of the patients was 28 years . 
 most gg 
 was found in the gingiva ( 73.17% ) , was reddish color and had a mean diameter of 1.5 cm . 
 local irritants were involved in 75.6% of the cases.conclusions:the hormonal conditions of pregnancy can have an impact on the oral cavity , 
 predisposing the patient to inflammatory lesions such as gg .