PG of the gingiva develops in up to 5% of pregnancies, hence the terms “pregnancy tumor” and “granuloma gravidarum” are often used. The hormonal imbalance coincident with pregnancy heightens the organism’s response to irritation, ; however, bacterial plaque and gingival inflammation are necessary for subclinical hormone alterations leading to gingivitis. Generally, it appears in the 2nd – 3rd trimester of pregnancy, with a tendency to bleed and a possible interference with mastication. Estrogen enhances vascular endothelial growth factor (VEGF) production in macrophages, an effect that is antagonized by androgens and which may be related to the development of pregnancy tumor. These regulatory effects of sex steroids may be manipulated as therapeutic or prophylactic measures in pregnancy tumor. Progesterone functions as an immunosuppressant in the gingival tissues of pregnant women, preventing a rapid acute inflammatory reaction against plaque, but allowing an increased chronic tissue reaction, resulting clinically in an exaggerated appearance of inflammation. Angiostatin was expressed significantly less in PG than in healthy gingiva and periodontally involved gingiva. The molecular mechanism for regression of pregnancy tumor after parturition remains unclear. It has been proposed that, in the absence of VEGF, Angiopoietin-2 (Ang-2) causes blood vessels to regress.
Pyogenic granuloma is one of the inflammatory hyperplasias seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection and in reality arises in response to various stimuli such as low-grade local irritation, traumatic injury, or hormonal factors. It predominantly occurs in the second decade of life in young females, possibly because of the vascular effects of female hormones. Clinically, oral pyogenic granuloma is a smooth or lobulated exophytic lesion manifesting as small, red erythematous growth on a pedunculated or sometimes sessile base, which is usually hemorrhagic. Although excisional surgery is the treatment of choice , some other treatment protocols such as the use of Nd:YAG laser, flash lamp pulsed dye laser, cryosurgery, intralesional injection of ethanol or corticosteroids, and sodium tetradecyl sulfate sclerotherapy have been proposed.
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