pyogenic granuloma ( pyg ) ( also known as a  eruptive hemangioma ,   granulation tissue - type hemangioma ,   granuloma gravidarum ,   lobular capillary hemangioma ,   pregnancy tumor  and  tumor of pregnancy  is primarily an oral disease which appears as an overgrowth of tissue due to irritation , physical trauma or hormonal factors . in actuality , it is a capillary hemangioma of the lobular subtype , which is the reason they are often quite prone to bleeding . it is also not truly  pyogenic ,  as the origin is mostly traumatic and not infectious . pyg arises in response to various stimuli such as chronic low - grade irritation , traumatic injury and hormonal factors . it predominantly occurs in young females in the second decade of life , possibly because of a vascular effect due to hormonal changes . the appearance of pyg is usually a color ranging from red / pink to purple , and can be smooth or lobulated . younger lesions are more likely to be red because of the high number of blood vessels . it can be painful , especially if located in an area of the body where it is constantly disturbed . it can also occur on the lips , tongue , buccal mucosa , palate and floor of the mouth . the diagnosis of pyg can be confirmed by preparing histological sections of the biopsy specimens . the treatment that has been widely used and often recommended is conservative surgical excision of the lesion , where the recurrence rates may vary from 0% to 16% . six female patients with a common complaint of swelling of gums in the oral midline of the lower arch accompanied by pain and difficulty during mastication reported to the department of periodontics and implantology , drs . sudha and nageshwara rao siddhartha institute of dental sciences , chinnaoutpalli , andhra pradesh , india . data regarding their age , sex , site , predisposing factors , clinical characteristics , histopathologic interpretation and treatment were duly recorded . on clinical examination , the size of the lesion varied from 1 cm in diameter up to 4 cm . in all the patients , the lesion was initially of a pin head size and then gradually increased to the present size . local factors were present around the teeth corresponding to the lesion in all patients . we have found in our subjects a combination or superimposition of etiologies , like chronic low - grade irritation from local factors , traumatic injury and hormonal factors . the treatment plan consisted of thorough oral prophylaxis comprising scaling and root planing to remove the local factors , followed by surgical excision using simple gingivectomy and histopathological examination of the excised mass . stratified squamous epithelium covering the circumscribed areas of dilated capillaries and endothelial proliferation accompanied by formation of vascular spaces was seen in all the cases . two of the lesions had an ulcerated surface with a zone of heavy infiltrate of neutrophils . proliferation of fibroblasts was observed in all the cases , with a more pronounced effect on the longstanding lesions . the patients were examined periodically after 1 week , 1 month , 3 months and 5 months , and no evidence of recurrence of swelling was observed . the clinical presentation of the six cases that reported to the department of periodontics and implatology , drs . sudha and nageshwara rao siddhartha institute of dental sciences , chinnaoutpalli , andhra pradesh , india , . clinical presentation of the six cases case 1 - pre - operative photograph case 1 - immediate post - operative photograph case 1 - three months post - operative case 2 - pre - operative case 2 - post - operative case 3 - pre - operative case 3 - post - operative case 4 - pre - operative case 4 - post - operative case 5 - pre - operative case 5 - post - operative case 6 - pre - operative case 6 - post - operative stratified squamous epithelium covering the circumscribed areas of dilated capillaries and endothelial proliferation accompanied by formation of vascular spaces was seen in all the cases . two of the lesions had an ulcerated surface with a zone of heavy infiltrate of neutrophils . proliferation of fibroblasts was observed in all the cases , with a more pronounced effect on the longstanding lesions . the patients were examined periodically after 1 week , 1 month , 3 months and 5 months , and no evidence of recurrence of swelling was observed . the clinical presentation of the six cases that reported to the department of periodontics and implatology , drs . sudha and nageshwara rao siddhartha institute of dental sciences , chinnaoutpalli , andhra pradesh , india , clinical presentation of the six cases case 1 - pre - operative photograph case 1 - immediate post - operative photograph case 1 - three months post - operative case 2 - pre - operative case 2 - post - operative case 3 - pre - operative case 3 - post - operative case 4 - pre - operative case 4 - post - operative case 5 - pre - operative case 5 - post - operative case 6 - pre - operative case 6 - post - operative it is a reactive inflammatory process filled with proliferating vascular channels , immature fibroblastic connective tissue and scattered inflammatory cells . gingiva is the most common site of occurrence , accounting for about 75% of the cases . according to vilmann et al . , majority of the pygs are found on the marginal gingival , with only 15% of the tumors on the alveolar part . other common sites are lips , tongue and buccal mucosa . because it is a reactive tumor - like lesion , chronic low - grade irritation , traumatic injury , hormonal factors and certain kind of drugs but , before treating any case , the etiology must be clearly identified and eradicated . before attempting surgical excision of the lesion , a thorough oral prophylaxis should be performed because local factors such as plaque and calculus are the most important etiologic factors for pyg . if the lesion is small , painless and free of bleeding , oral prophylaxis , removal of causative irritants ( foreign materials , source of trauma ) and follow - up are advised . lesions of large size are treated by a thorough oral prophylaxis followed by surgical excision using gingivectomy or flapsurgery procedures . lasers such as nd : yag and co2 laser can also be used for surgical excision with minimal bleeding . ishida and ramos - e - silva believed that cryosurgery is a very useful technique for the treatment of pyg . reported that sodium tetradecyl sulfate sclerotherapy successfully cleared the lesions in most patients without major complications . parisi et al . used a series of intralesional corticosteroid injections for the treatment of pyg , particularly highly recurrent lesions . a preventive measure consists of adequate home care measures with regular dental check up and oral prophylaxis , especially during pregnancy . recurrence is believed to result from incomplete excision , failure to remove etiologic factors or re - injury of the area . some recurrences manifest as multiple deep satellite nodules that surround the site of the original lesion . differential diagnosis of pyg includes peripheral giant cell granuloma , peripheral ossifying fibroma , peripheral odontogenic fibroma , hyperplastic gingival inflammation , kaposi 's sarcoma , bacillary angiomatosis , angiosarcoma , metastatic cancer and hemangioma . in our case reports , surgical excision of the lesion was curative , but one case of recurrence was reported in a pregnant woman in the second trimester , where the surgical procedure was repeated accompanied by thorough root planing that proved to be effective . this recurrence may be due to the effect of sex hormonal imbalances during pregnancy , which is one of the most common causes of pyg . in all the above cases , pygs were found to occur close to the midline of the lower anteriors . further observation of such cases will provide a better understanding of the occurrence of pyg in the midline of the lower anteriors .
pyogenic granuloma ( pyg ) is a common cause of swelling in the oral cavity during pregnancy and also as an exaggerated response to any minor trauma . 
 the condition is frequently associated with periodontal pain and discomfort , in some cases interfering with mastication and creating esthetic problems . 
 six patients reported to the department of periodontics with gingival overgrowth in the lower anteriors . 
 after recording the details of the patients oral hygiene status , all the patients were provided initial therapy with scaling and were prescribed analgesics for the reduction of pain and discomfort . after 1 week , surgical excision of the overgrowth was performed and sent for histopathological analysis . 
 the histopathological report is suggestive of pyg .