Pyogenic granuloma associated with a natal tooth: case report.

The pyogenic granuloma is a clinical entity which originates as an overexuberant connective tissue response to a stimulus or injury.^ Trauma and local irritation have a significant impact on the development of the pyogenic granuloma. This lesion is particularly important to dentists because of its common intraoral occurrence and sometimes alarming clinical course. The pyogenic granuloma is seen most frequently on the gingiva, but occasionally is found elsewhere in the mouth in areas of frequent trauma such as the lips, the buccal mucosa, and the tongue. Previous dental extractions, exfoliating primary teeth, bone spicules, root remnants, toothbrush trauma, and gingival irritation from bacterial plaque and calculus have been reported as possible etiologic factors of pyogenic granuloma at gingival sites. It now generally is agreed that the pyogenic granuloma is not a response to any specific infective agent. The lesion is usually an elevated, pedunculated, or sessile mass. The surface may be smooth, lobulated, or even warty. The pyogenic granuloma is typically deep red or reddish-purple due to its vascularity, but may have a brown cast of hemorrhage. These lesions usually are ulcerated, and subsequently become covered by a yellow-tan fibrinous exudate. Pyogenic granulomas do not produce pus, as the term "pyogenic" implies.' The pyogenic granuloma may develop rapidly, reach full size, then remain static. Hormonal changes of puberty and pregnancy may modify the clinical course. Pyogenic granulomas are associated so frequently with pregnancy that the term "pregnancy tumor" has been used. The lesions range in size from a few millimeters to several centimeters in diameter. They have no apparent predilection for any age group, but tend to occur in females more frequently than males.' Treatment for the pyogenic granuloma involves conservative local excision, except in cases of hormonal (e.g., pregnancy) tumors. In cases of "pregnancy tumors," the lesions usually are left untreated until postpartum when they may resolve, or lessen in severity. Because the lesions are not encapsulated, their limits are hard to define. The surgeon must be careful to excise the connective tissue from which the lesion arises, and to remove any etiologic factors.' 3 Pyogenic granulomas recur occasionally, probably due to incomplete excision, failure to remove etiologic factors, or reinjury. Our case report presents a pyogenic granuloma associated with a natal tooth. This case suggests that the extraction of a natal tooth may have stimulated the development and rapid clinical growth of a pyogenic granuloma.