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Clinical and Histological Evaluation of Granuloma Gravidarum:
Case Report

Yara Teresinha Corrêa SILVA-SOUSA1
Claudia Mendonça Pinto COELHO1
Luiz Guilherme BRENTEGANI2
Mara Lucia Senna Oliveira VIEIRA1
Marcelo Leipner de OLIVEIRA3
1Faculdade de Odontologia, Universidade de Ribeirão Preto
2Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo
3Dental SurgeonRibeirão Preto, SP, Brasil

Braz Dent J (2000) 11(2): 135-139 ISSN 0103-6440
Introduction | Case Report | Discussion | Resumo | References

Granuloma gravidarum is a benign lesion of the oral mucosa which occurs during pregnancy. This case report presents the clinical and histological evaluation and treatment of a granuloma gravidarum in a patient in the 9th month of pregnancy.

Key Words:granuloma gravidarum, pregnancy tumor, pyogenic granuloma, pregnancy complications.

Introduction
Granuloma gravidarum (pregnancy tumor) is a pyogenic granuloma which develops on the gingiva during pregnancy. This benign hyperplastic lesion of the oral mucosa occurs in up to 5% of pregnancies. This rapidly growing lesion is typically a painless sessile or pedunculated gum mass, of varieddiameter. Spontaneous hemorrhage or bleeding following brushing is observed in some cases. Maxillary tumors are more common than mandibular (Sills et al., 1996). Although less common, this lesion may appear on the tongue (Fenton et al., 1996).
Histologically, granuloma gravidarum presents loose granulation tissue rich in capillary vessels and proliferation of endothelial cells, typically accompanied bya mixture of infiltrated inflammatory cells. A thin epithelial layer overlies the lesion and is often ulcerated due to trauma associated with eating or tooth brushing (Sills et al., 1996).
Management of granuloma gravidarum depends on the severity of the symptoms. If the lesion is small, painless and free of bleeding, clinical observation and follow-up are advised (Sills et al., 1996). Steelmanand Holmes (1992) reported that maintenance of oral hygiene and regular follow-up appointments while pregnant should be recommended. During pregnancy, surgery should be recommended if bleeding or pain from the lesion impedes routine brushing or other daily activities (Sills et al., 1996), or after delivery if the lesion has not regressed completely (Butler and Macintyre, 1991; Tumini et al.,1998).
Powell et al. (1994) reported the use of Nd:YAG laser for the excision of this tumor in a patient in the 36th week of pregnancy because of the lower risk of bleeding compared to other surgical techniques.
This report presents a case of granuloma gravidarum in a patient in the last month of pregnancy.

Case Report
This 19-year-old Negro woman in the 9th month of pregnancy was examinedat the Stomatology Clinic of the Faculty of Dentistry (UNAERP, Ribeirão Preto, SP, Brazil) presenting a polypoid sessile gum mass, with intense reddish color, and bleeding on touch. This mass involved both buccal and lingual regions of the maxillary pre-molars and molars on the right side at the muco-gingival line (Figure 1) and there was bacterial plaque and calculus present.
Basic periodontaltreatment, including scraping and prophylaxis, and instructions on oral hygiene were carried out at the first visit. The patient returned to the Clinic after delivery for follow-up. The lesion had decreased in size (Figure 2, top). A program of supervised oral hygiene to improve gingival status and lesion regression was carried out.
Because the lesion did not regress completely, five months afterparturition the lesion was re moved surgically (Figure 2, bottom). One week before the surgical excision of the lesion, basic periodontal treatment, including scraping and root planing and instructions on oral hygiene were preformed to decrease gingival inflammation. After tissue excision, residual calculus was removed and root planing done. To obtain better gingival contour, a gingivoplasty...