Bleeding gingival mass in pregnancy

§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

§Differential diagnosis

§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.

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