Self-progressing Granulomatous Growth in Pediatric Patients: Pyogenic Granuloma? International Journal of Preventive and Clinical Dental Research, October-December 2016;3(4):299-302 299 IJPCDR Self-progressing Granulomatous Growth in Pediatric Patients: Pyogenic Granuloma? 1 Unnati Pitale, 2 Ami Kandya, 3 Manish Varma, 4 Hitesh Mankad, 5 Vinaya K Kulkarni, 6 Rohit Pandey IJPCDR CASE REPORT 10.5005/jp-journals-10052-0067 1,5 Professor and Head, 2-4,6 Postgraduate Student 1,3,4,6 Department of Periodontics, Modern Dental College and Research Centre, Indore, Madhya Pradesh, India 2 Department of Pedodontics and Preventive Dentistry, Modern Dental College and Research Centre, Indore, Madhya Pradesh India 5 Department of Pedodontics and Preventive Dentistry, SMBT Dental College, Sangamner, Maharashtra, India Corresponding Author: Manish Varma, Postgraduate Student Department of Periodontics, Modern Dental College and Research Centre, Indore, Madhya Pradesh, India, e-mail: idamanish@ yahoo.co.in ABSTRACT Fibrous overgrowths of soft tissues in oral cavity are relatively common and may be quite challenging to diagnose. Pyogenic granuloma is one such entity which occurs commonly in response to chronic local irritation, e.g., calculus, fractured tooth or restoration, foreign materials, etc. It occurs predominantly in females, probably due to the action of female hormones. These lesions are generally asymptomatic and are reported only due to diffculty in mastication. Treatment includes complete excision of the lesion along with the removal of causative factor. This paper describes a case of pyogenic granuloma in a ten-and- a-half-year-old girl, presenting with a single, irregular, reddish maxillary gingival swelling in relation to mobile 63. Keywords: Exophytic growth, Fibrous overgrowth, Pyogenic granuloma. How to cite this article: Pitale U, Kandya A, Varma M, Mankad H, Kulkarni VK, Pandey R. Self-progressing Granulomatous Growth in Pediatric Patients: Pyogenic Granuloma? Int J Prev Clin Dent Res 2016;3(4):299-302. Source of support: Nil Confict of interest: None INTRODUCTION Diagnosis of any exophytic growth in oral cavity is one of the challenges in dentistry, because a diverse group of pathologies can produce such lesions. It may be due to many causes, such as any developmental anomaly, inflam- mation, cysts, hyperplasia, neoplasm, 1 due to reaction to some drugs, like retinoic acid, oral contraceptives, indina- vir, etc. 2,3 Hyperplasia may also be caused in response to any chronic, recurring tissue injury or any local irritation, insect bite or imbalance in hormonal levels. 1 Pyogenic granuloma is one of the most common exophytic growths in the oral cavity. 4 However, the term “pyogenic granuloma” is a misnomer. 5 Based on the histological considerations, it is a lobular capillary hem- angioma 6 or focal fibrous hyperplasia. 7 It is a painless, hyperplastic mass of soft tissue which may be peduncu- lated or sessile, red or purple in color. 7 It may be painful sometimes, in case the growth is constantly exposed to mastication. In around one-third of the cases, lesions are caused by any kind of trauma, and poor oral hygiene may be one of the precipitating factor. 8 In oral cavity, pyogenic granuloma most commonly occurs on gingiva (on maxillary buccal surface). This disorder can be seen at any age but young adults are more commonly affected, females being more prone than males. 9 The treatment can be done conservatively by excision of lesion and maintenance of oral hygiene. CASE REPORT A ten-and-a-half-year-old female patient reported with a complaint of pain and swelling on upper front tooth region since one-and-a-half month. The growth initially was rice sized, which progressed slowly and attained the present size, gradually causing difficulty in mastication. This was her first dental visit. Medical and family histo- ries were noncontributory; however, she had a history of facial burn in childhood. Extraorally, strictures could be seen on lower half of her face due to burn injury, which led to restricted mouth opening. No facial asymmetry was found. Submandibu- lar or sublingual lymph nodes were nontender. Intraoral examination disclosed a bluish red pedunculated growth on buccal maxillary gingiva, which was approximately 2.5 × 1.5 cm in size. The growth extended from mesial surface of 63 to the middle surface of 65 anteroposteriorly (Fig. 1A) and buccopalatally extending from occlusal surface of 63, covering its crown up to palatal aspect (Fig. 1B). The indentations of mandibular teeth could be seen on occlusal surface of the growth. On palpation, the gingival growth was soft in consistency, nontender, and was bleed- ing on probing. Grade III mobility was seen with respect to 63. Patient had poor oral hygiene with large amount of calculus and deposits (which may be due to inability to open the mouth properly). Orthopantomogram examina- tion revealed ectopically erupting 24 beneath the growth.