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OMFS-0127PathologybeginnerMaxillary anterior gingiva
Bleeding gingival mass in pregnancy
27-year-old female
Draft — educational study aid, pending faculty review.
§Chief complaint
Lump on the gum that bleeds when brushing, growing for 6 weeks
§Medical & dental history
- 0128 weeks pregnant, otherwise well
- 02Plaque accumulation and gingival inflammation; calculus present
§Clinical examination
- 01Pedunculated, soft, bright red mass 14 mm on the interdental papilla between 12 and 11
- 02Bleeds readily on gentle probing
- 03No bone loss on probing; teeth vital and non-mobile
- 04No other lesions
§Figures
Verified clinical, radiology and histopathology images not yet available
§Differential diagnosis
Pyogenic granulomaRapidly growing, bleeding, pregnancy, plaque-related
Peripheral giant cell granulomaBluish-purple, may cause cupping bone resorption
Peripheral ossifying fibromaFirmer, arises from the papilla, radiopaque flecks
Metastatic lesion or Kaposi sarcomaRare; consider if risk factors present
§Final diagnosis
Pyogenic granuloma (pregnancy epulis) of the maxillary anterior gingiva
A soft, bright red, easily bleeding pedunculated gingival mass appearing during pregnancy with local plaque irritation is a pyogenic granuloma. A bluish hue with underlying bone cupping would favour a peripheral giant cell granuloma.
§Investigations
- 01Periapical radiograph — no bone loss or radiopacity within the lesion
- 02Excisional biopsy after delivery unless symptoms demand earlier removal
§Treatment plan
- 01Meticulous plaque control and professional scaling — many regress after delivery
- 02Excision to periosteum with removal of local irritants if it persists or bleeds excessively
- 03Timing: second trimester or post-partum where possible
§Surgical procedure
- 01Excision to periosteum with adjacent scaling and root planing under local anaesthesia at 8 weeks post-partum
§Histopathology report
Lobular proliferation of endothelial cells forming numerous small vascular channels in an oedematous stroma with a mixed inflammatory infiltrate and surface ulceration. Lobular capillary haemangioma (pyogenic granuloma).
§Follow-up & outcome
- 01Complete healing at 3 weeks
- 02No recurrence at 12 months with maintained oral hygiene
§Clinical pearls / learning points
- 01Recurrence is due to retained irritants — excise to periosteum and clean the adjacent teeth.
- 02Not pyogenic and not a granuloma: it is a lobular capillary haemangioma.
- 03Consider deferring elective excision until after delivery unless bleeding is problematic.
§References
- Neville BW et al. Oral and Maxillofacial Pathology, 5th ed.
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