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 Table of Contents  
CASE REPORTS
Year : 2019  |  Volume : 13  |  Issue : 1  |  Page : 28-31

Management of oral pyogenic granuloma with profuse gingival bleeding using laser in paediatric patient


1 Department of Pedodontics and Preventive Dentistry, SJM Dental College, Chitradurga, Karnataka, India
2 Department of Periodontics, SJM Dental College, Chitradurga, Karnataka, India
3 Department of Oral Pathology, SJM Dental College, Chitradurga, Karnataka, India

Date of Web Publication24-Jul-2019

Correspondence Address:
Dr. Hurlihal Sharath Chandra
Department of Pedodontics and Preventive Dentistry, SJM Dental College, PB Road, Chitradurga 577501, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdl.jdl_15_18

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  Abstract 

Pyogenic granuloma (PG) is a tumor-like nonneoplastic hyperplastic lesion of oral cavity occurring in response to various stimuli, of which chronic irritation and hormones influence pathogenesis predominantly. Lesion has high vascularity with numerous capillaries with severe bleeding tendency even with slight touch. Surgical excision of the tissue is the treatment of choice for which lasers would be the preferred choice owing to its lesser intraoperative bleeding, superior coagulation ability, wound sterilization, minimal pain, invasiveness, and lack of need for suturing or packing with better postoperative healing. This case report is about a teenage girl with severe PG managed using diode laser.

Keywords: Diode lasers, hyperplastic lesion, pyogenic granuloma


How to cite this article:
Chandra HS, Rudrappa D, Reddy MH, Britto F. Management of oral pyogenic granuloma with profuse gingival bleeding using laser in paediatric patient. J Dent Lasers 2019;13:28-31

How to cite this URL:
Chandra HS, Rudrappa D, Reddy MH, Britto F. Management of oral pyogenic granuloma with profuse gingival bleeding using laser in paediatric patient. J Dent Lasers [serial online] 2019 [cited 2019 Aug 19];13:28-31. Available from: http://www.jdentlasers.org/text.asp?2019/13/1/28/263342




  Introduction Top


A diverse group of pathologic processes can produce soft-tissue enlargements of the oral cavity, often presenting a diagnostic challenge. Such an enlargement can be variation of normal anatomic structures, developmental anomalies, inflammation, neoplasm, and cysts. In response to a chronic, recurring tissue injury causing an exuberant or excessive tissue repair response is a group of reactive hyperplasias. Pyogenic granuloma (PG) is one such inflammatory hyperplastic lesion considered as nonneoplastic tumor-like growth of the oral cavity or the skin.[1]

PG clinically presents as a soft, smooth, or lobulated exophytic lesion, which manifests as a small, red erythematous papule on a pedunculated or sessile base.[1],[2] Lesion has greater predilection in women (1.5:1 ratio) occurring most frequently in the second and third decades of life[3],[4] because of high levels of female hormones, which exhibit vascular effects[5] and play important role in its pathogenesis. The most common sites of occurrence are gingiva, followed by lips, tongue, and buccal mucosa with no radiographic findings, and final diagnosis of PG can be established through histological examination only.[6]

Complete excision of the tissue is the treatment of choice for which laser-assisted surgeries are preferred in pediatric patients as they are more tolerable and less anxiety provoking with minimal postoperative complications. In this case report, we highlight the case of teenage girl with severe gingival enlargement and overnight profuse gingival bleeding managed using diode laser.


  Case Report Top


A 12-year-old female patient reported to the department of pedodontics and preventive dentistry with the chief compliant of swelling of gums associated with pain on mastication for 5–6 months. Parent expressed the concern of drooling of blood-filled saliva during night and inability to chew and brush on the affected side. Swelling of gums started 5 months back, which gradually increased to present size. Medical history was noncontributory. On intraoral soft-tissue examination, a smooth solitary gingival enlargement measuring 2 × 1cm covering the tooth 24; 25 buccally, palatally, and occlusally; and 23 on the palatal side was seen. Tissue was reddish, edematous, soft friable, and hemorrhagic, and bleeds spontaneously on touch. Similar type of enlargement was seen involving tooth 35 [Figure 1] and [Figure 2]. On the basis of age, history, and clinical examination, a diagnosis of PG was given, and differential diagnosis of peripheral giant cell granuloma, peripheral ossifying fibroma, hemangioma, peripheral fibroma, Kaposi’s sarcoma, and metastatic tumor was given. As hemogram of the patient was normal, incisional biopsy was taken and the patient was sent for histopathological examination.
Figure 1: Maxillary intraoral view

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Figure 2: Mandibular intraoral view

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Histopathological specimen showed parakeratinized stratified squamous epithelium with stroma showing abundant endothelial lined blood vessels with prominent inflammatory infiltrates. On the basis of clinical findings and histological examination, a diagnosis of PG was given [Figure 3].
Figure 3: Histopathological examination

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After administering prophylactic antibiotics, complete excision of enlarged tissue was carried out using diode laser and thorough curettage was performed to eliminate granulation tissue under local anesthesia [Figure 4]. Periodontal pack was placed and the patient was recalled after 1 week. On the recall visit, periodontal pack was removed and thorough scaling was carried out. Healing of the affected site was uneventful and the patient was advised oral hygiene maintenance [Figure 5]. Patient was followed up after 1 and 2 months, and the results were satisfactory [Figure 6].
Figure 4: Excision of pyogenic granuloma using diode laser

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Figure 5: Postoperative view after 1 week

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Figure 6: Postoperative view after 1 month

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  Discussion Top


Exact etiopathogenesis of PG is still debatable; however, it is usually considered as a reactive lesion, which is thought to arise in response to various stimuli such as chronic low-grade local irritation,[1] traumatic injury, hormones,[7] drugs,[8] and viral and bacterial infections.[9] Poor oral hygiene has also been noticed to be associated with PGs by some authors.[1]

Even a minor trauma can cause a considerable hemorrhage because of high vascularity of the lesion, and intensity of hemorrhage is more in young PGs because of the abundant presence of hyperplastic granulation tissue and prominent capillaries,[10] which was evident in this case.

Treatment of PG depends on the size and location of the lesion with excisional biopsy as the treatment of choice in the majority of the cases. As in this case it was a large lesion, an incisional biopsy was carried out to rule out other pathologies, to confirm the diagnosis of PG, and to avoid large deformity following complete excision of the tissue.

Various treatment modalities of PG include (a) Surgical excision (b) Conservative methods such as cryosurgery, electrodessication and an injection of absolute ethanol (c) Sodium tetradecyl sulfate sclerotherapy; (d) Nd: YAG, CO2, and flash lamp pulsed dye lasers. Diode lasers are frequently been used to surgically excise the lesion owing to its superior coagulation properties and lesser intraoperative bleeding,[9] with clarity at the surgical site, wound sterilization, minimal pain, invasiveness, and lack of need for suturing or packing[4] with uneventful postoperative healing.

A recurrence rate of 16% has been reported.[11] Recurrence can be prevented by oral hygiene maintenance that includes proper brushing technique using soft tooth brush and periodic follow up for oral examination.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Neville BW, Damm DD, Allen CM, Bouquot J. Oral & Maxillofacial Pathology. 2nd ed. Philadelphia, PA: WB Saunders; 2002; 437-95.  Back to cited text no. 1
    
2.
Eversole LR. Clinical Outline of Oral Pathology: Diagnosis and Treatment. 3rd ed. Hamilton, Canada: BC Decker; 2002. p. 113-4.  Back to cited text no. 2
    
3.
Aguilo L. Pyogenic granuloma subsequent to injury of a primary tooth. A case report. Int J Paediatr Dent 2002;12:438-41.  Back to cited text no. 3
    
4.
Shenoy SS, Dinkar AD. Pyogenic granuloma associated with bone loss in an eight year old child: A case report. J Indian Soc Pedod Prev Dent 2006;24:201-3.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Lawoyin JO, Arotiba JT, Dosumu OO. Oral pyogenic granuloma: A review of 38 cases from Ibadan, Nigeria. Br J Oral Maxillofac Surg 1997;35:185-9.  Back to cited text no. 5
    
6.
Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: A review. J Oral Sci 2006;48:167-75.  Back to cited text no. 6
    
7.
Mussalli NG, Hopps RM, Johnson NW. Oral pyogenic granuloma as a complication of pregnancy and the use of hormonal contraceptives. Int J Gynaecol Obstet 1976;14:187-91.  Back to cited text no. 7
    
8.
Miller RA, Ross JB, Martin J. Multiple granulation tissue lesions occurring in isotretinoin treatment of acne vulgaris–successful response to topical corticosteroid therapy. J Am Acad Dermatol 1985;12:888-9.  Back to cited text no. 8
    
9.
Bhaskar SN, Jacoway JR. Pyogenic granuloma—clinical features, incidence, histology, and result of treatment: Report of 242 cases. J Oral Surg 1966;24:391-8.  Back to cited text no. 9
    
10.
Singh RK, Kaushal A, Kumar R, Pandey RK. Profusely bleeding oral pyogenic granuloma in a teenage girl [published online ahead of print March 12, 2013]. BMJ Case Rep 2013.  Back to cited text no. 10
    
11.
Kfir Y, Buchner A, Hansen LS. Reactive lesions of the gingiva. A clinicopathological study of 741 cases. J Periodontol 1980;51:655-61.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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