Early lesions bleed easily due to extreme vascularity. Pyogenic granulomas can have a rapid growth pattern that can cause alarm. The typical lesion involves the interproximal gingiva and increases in size to cover a portion of the adjacent teeth. A number of lesions will affect both the facial and lingual gingivae. As lesions mature, the vascularity decreases and the clinical appearance is more collagenous and pink.
Pyogenic granulomas vary in size from a few millimeters to several centimeters and are painless.
These tumors are soft to palpation. Obtain a periapical radiograph of the associated teeth in lesions that involve the teeth. The x-ray findings are negative if the lesion is a pyogenic granuloma. If calcifications are present, then the lesion probably would be a peripheral ossifying fibroma, which is clinically identical to the pyogenic granuloma and requires the same treatment of removal with scaling of the adjacent teeth. Histologic examination reveals sectioned soft tissue consisting of a lesion composed of ulcerated mucosa covering a core of cellular fibrous connective tissue admixed with proliferating vascular channels and a mixed inflammatory infiltrate.