FIGURE 1 : Ulcerated , erythematous , dome-shaped pyogenic granuloma of the anterior maxillary palatal gingiva .
FIGURE 2 : Pink , dome-shaped peripheral ossifying fibroma of the right posterior maxilla . Note the severe periodontal disease and heavy plaque and calculus deposits . Such irritants are commonly associated with development of reactive gingival lesions .
PYOGENIC GRANULOMA
Pyogenic granulomas ( PGs ) are benign vascular growths that can arise anywhere in the oral cavity , but approximately 80 percent occur on the gingiva . 1 A study of 302 reactive fibrous lesions of the gingiva found approximately one-third to consist of PGs . 2 Most lesions occur in female patients and maintain a multifactorial etiology including irritation , inflammation , trauma , or hormonal influences during pregnancy . 1 , 2 Because the lesion has been found in 5 percent of pregnancies due to hormonal imbalances , PGs are sometimes referred to as “ oral pregnancy tumors .” 3 Younger PGs have an erythematous , vascular appearance , while older lesions can appear more pink due to the deposition of collagen . 1 Given the vascular nature of the lesion , bleeding is the predominant sign . Ulceration of the overlying epithelium is also present in a number of cases ( Figure 1 ). Histopathologically , PGs appear as highly vascular proliferations , which are sometimes arranged in a lobular pattern . 1 If this is the case , they may also be referred to as “ lobular capillary hemangiomas .” Surgical excision with clear margins constitutes the treatment of choice . However , the literature reports recurrence rates of 14.8 percent after surgery for PGs . 4 Of note , PGs occurring during pregnancy have a higher rate of recurrence than sporadic cases ; and , moreover , they may regress spontaneously following childbirth . 1 For this reason , excision should be deferred in most cases .
PERIPHERAL FIBROMA
Peripheral fibromas , similar to pyogenic granulomas , have been reported in all locations in the oral cavity and frequently develop in the context of physical irritation . 2 Clinically , most peripheral fibromas are enveloped by a smooth , pink surface . Histopathologically , they appear as well-defined , asymptomatic lesions composed of fibrocollagenous tissue with variable vascularity . One common variant that has a propensity for palatal tissues is the “ giant cell fibroma ” which retains a more roughened , papillary surface . Histopathologically , the giant cell fibroma is comprised of multinucleated , stellate-shaped cells interspersed amidst fibrils of collagen . 1 Conservative surgical excision is the treatment of choice .
PERIPHERAL OSSIFYING FIBROMA AND PERIPHERAL GIANT CELL GRANULOMA
Peripheral ossifying fibromas ( POF ) and peripheral giant cell granulomas ( PGCG ) comprise approximately one-quarter of non-odontogenic reactive hyperplasias on the gingiva . Unlike PGs , both PGCGs and POFs only occur on the gingiva or edentulous alveolar ridge . 1 POFs arise primarily in the anterior gingiva of both the maxilla and mandible , while PGCGs mostly occur on the mandibular gingiva anterior to the molars . 2 They may present clinically with surface ulceration . PGCGs often have a purplishhemorrhagic appearance . Longstanding POFs frequently can appear pink ( Figure 2 ). 1 Histologically , POFs have a conspicuously cellular stroma along with hard tissue deposition that may be prominent or subtle in young lesions and are correspondingly , firmer to palpation . Histopathologically , PGCGs are notoriously vascular with red blood cell extravasation and hemosiderin pigmentation . Additionally , multinucleated giant cells , composed of greater than 10 nuclei , dominate the stroma . 1 PGCGs have the potential for cupping bone resorption of the area underlying the lesion leading to mobility of the teeth . 1 POFs and PGCGs are more aggressive and possess a higher recurrence rate ( 12-20 %) compared to pyogenic granulomas and peripheral fibromas . Nonetheless , surgical excision with clear margins down to the underlying bone is curative in the majority of cases and represents the standard of care for these lesions . 5-7
MAY / JUNE 2018 | PENNSYLVANIA DENTAL JOURNAL 25