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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 2  |  Issue : 2  |  Page : 112-114

Pregnancy tumor: A rare case report in mandibular anteriors


1 Department of Oral Medicine and Radiology, Private Practice, Jind, Haryana, India
2 Department of Prosthodontics, Private Practice, Jind, Haryana, India

Date of Submission06-May-2017
Date of Acceptance22-Aug-2017
Date of Web Publication15-Dec-2017

Correspondence Address:
Dr. Swati Phore
Department of Oral Medicine and Radiology, Private Practice, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_13_17

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  Abstract 


Pregnancy in a woman's life is associated with a variety of physiological, anatomical, and hormonal changes that can affect the cardiovascular, respiratory, and gastrointestinal systems. Such hormonal changes may lead to periodontal diseases and may be associated with generalized or localized gingival enlargements. Pregnancy does not cause the condition, but altered tissue metabolism in pregnancy accentuates the response to the local irritants, thereby causing gingival enlargements. In this report, a 25-year-old pregnant female had a localized gingival enlargement in the labial aspect of the mandibular anterior region.

Keywords: Granuloma, pregnancy, pyogenic


How to cite this article:
Phore S, Panchal RS. Pregnancy tumor: A rare case report in mandibular anteriors. BLDE Univ J Health Sci 2017;2:112-4

How to cite this URL:
Phore S, Panchal RS. Pregnancy tumor: A rare case report in mandibular anteriors. BLDE Univ J Health Sci [serial online] 2017 [cited 2020 Aug 13];2:112-4. Available from: http://www.bldeujournalhs.in/text.asp?2017/2/2/112/220934



Pregnancy tumor is a benign, nonneoplastic overgrowth, mostly affecting the gingiva of a pregnant female. It is a variant of pyogenic granuloma but occurring in pregnant females. It is mostly associated with poor oral hygiene, which serves as an irritant. Pregnancy has been observed to increase susceptibility to gingival inflammation, leading to gingival and periodontal diseases. The etiology of pregnancy tumor is unknown, but local factors such as infection, irritation, poor oral hygiene, hormonal changes, or certain kinds of drugs can be some of the predisposing factors.[1]

It was first described in 1897 by two French surgeons Poncet and Dor and named it human botryomycosis. The term pyogenic granuloma was proposed by Hartzell in 1904, although it is a misnomer since the condition is not associated with pus and does not represent a true granuloma.[2],[3]

They are also known as Granuloma Gravidarum, Granuloma of pregnancy, Pregnancy epulides, Crocker and Hartzell's disease, Teleangiectaticum granulomatosa, and Lobular capillary hemangioma.[4],[5]

This rapidly growing tumor usually appears during the 2nd or 3rd month of pregnancy. Although an involution usually occurs after parturition, interference with the function may make the excision of the tumor inevitable. Apart from the fact that it occurred with the effects of hormonal changes during the pregnancy, in fact, its difference in the histopathological level with pyogenic granuloma observed in males and the females who are not pregnant was not demonstrated. The greatest difference from pyogenic granuloma is to occur in response to the hormonal changes in pregnancy and to slow down itself within the several weeks after the hormonal changes eliminated together with the end of pregnancy.[6]

In this case, the lesion was on mandibular anterior gingiva in contrast to the literature reporting it to be more common on maxillary anterior region.


  Case Report Top


A 27-year-old female patient reported to the outpatient department with a chief complaint of swelling in lower front region of oral cavity for 2–3 months. There was no pain associated with the lesion. Patient experienced bleeding on brushing and difficulty in mastication and speech. The patient was 6 months pregnant. Intraoral examination revealed soft tissue mass in anterior region of 41.42. It was pinkish red and 1.5 cm × 1.5 cm in size. It had a smooth surface and had 9 mm deep pseudopocket [Figure 1]. On palpation, it was soft in consistency, slight bleeding on palpation was present without ulceration. Intraoral periapical radiograph revealed mild horizontal bone loss.
Figure 1: Localized gingival swelling, in labial gingiva with respect to 41.42 with 9 mm pseudopocket

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The patient was unable to maintain oral hygiene in this area, because of gingival enlargement, rest of oral cavity showed normal gingiva and satisfactory oral hygiene. A provisional diagnosis of pregnancy tumor was made. Differential diagnosis of peripheral giant cell granuloma was made. Routine blood examination was carried out, with all values lying within the normal limits. Oral prophylaxis was done, which resulted in the removal of plaque, calculus, and reduction in gingival inflammation. After a reduction in inflammation, surgical excision was planned. Before surgery, 0.2% chlorhexidine mouthwash was used as a preprocedural rinse. Excision was performed using 15 number blade after giving local anesthesia. After removing the overgrowth, excised lesion was sent for histopathological examination [Figure 2]. Periodontal dressing was placed on the surgical area, postoperative instructions were given, and the patient was placed on medications.
Figure 2: Excised lesional growth

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The histopathological report under low power revealed irregular stratified squamous hyperkeratinized epithelium overlying fibrovascular and cellular connective tissue stroma. Under higher magnification, the connective tissue stroma comprised of loose to dense bundles of collagen fibers with predominantly plump-shaped fibroblasts. Numerous endothelial lined blood vessels (few dilated) with red blood cells and extravasated red blood cells were evident. Budding capillaries along with endothelial cell proliferation were also seen in many areas. Chronic inflammatory cells predominantly comprising of lymphocytes and few plasma cells were evident. On the basis of histopathological report and clinicopathological correlation, a final diagnosis of pyogenic granuloma was made.

The patient was recalled for follow-up examination after 10 days to see the healing and gingival tissue status. Instructions regarding maintenance of oral hygiene were given. Early healing was uneventful [Figure 3]. No recurrence has been observed for 6-month follow-up. The patient was reinstructed for oral hygiene maintenance.
Figure 3: Healed area after 10 days follow-up

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  Discussion Top


In 1946, Ziskin and Ness compiled a clinical classification of pregnancy gingivitis as follows:

  • Class I: Characterized by bleeding gingiva with more or less no other manifestations
  • Class II: Characterized by changes in interdental papilledema and swelling with exhibits a tendency to recur. Subsequent blunting of interdental papilla
  • Class III: Characterized by the involvement of the free gingival margin, which takes on the color and general appearance of a raspberry
  • Class IV: Generalized hypertrophic gingivitis of pregnancy
  • Class V: The pregnancy tumor.[7]


During pregnancy estrogen and progesterone levels rise, which create an enhanced tissue response to chronic low-grade irritation (plaque, calculus, irregular dental restorations) in the oral cavity.[8]

The subgingival flora changes to a more anaerobic flora as pregnancy progresses and  Prevotella intermedia Scientific Name Search re the microorganism that increases significantly during pregnancy. The increase is due to elevations of levels of systemic estradiol and progesterone. It has been suggested that the altered tissue response to plaque is due to depression of the maternal T lymphocyte. The gingiva has been shown to be a target organ for female sex hormones. Therefore, the maintenance of oral hygiene before and during pregnancy is very important to reduce the incidence and the severity of gingival inflammation.[9]

In all forms of gingival enlargements, good oral hygiene is necessary to minimize the effects of systemic factors. Although the spontaneous reduction in the size of gingival enlargement commonly occurs following childbirth, complete elimination of residual inflammatory lesions requires the removal of all forms of local irritants.[10]

Pregnancy tumor occasionally recurs in up to 16% of the lesions if removed during pregnancy due to incomplete excision, failure to remove etiological factors and reinjury to the area.[11]

The patient if given thorough dental prophylaxis and oral hygiene instructions and then chances of resolution of tumor are there for parturition. Therefore, maintenance of oral hygiene and regular follow-up appointments should be recommended for pregnant women.[12]


  Conclusion Top


Consequently, the fact that pregnancy tumor, one of the diseases of the pregnancy period, having serious complications is known by the gynecologists is invaluable for the attention which should be given by assessing accurately the symptoms related to the mouth health of the patients. The importance of the oral hygiene and the usage of the soft tooth brushes must be taught all pregnants by the gynecologist physicians so that the development of the disease could be prevented rather than provided the treatment and the diagnosis of the disease.

Due to the interference of the lesion in day-to-day mastication, and oral hygiene maintenance, it was surgically excised. Preventive follow-up of the pregnant patient is necessary to avoid periodontal diseases related to hormonal alterations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Agarwal H, Manjunath RG, Agarwal A, Garg V, Mittal P, Rastogi A. Pregnancy tumor: A concern for pregnant females. J Dent Sci Oral Rehab 2016;7:191-4.  Back to cited text no. 1
    
2.
Esmaeli N, Sharmila B, Sangeeta M, Rahul K. A case report of pregnancy tumor and its management using the diode laser. J Dent Lasers 2012;2:68-71.  Back to cited text no. 2
    
3.
Priya K, Sekar B, Augustine D, Murali S. Persistent pregnancy tumor: A case report with review of literature. Oral Maxillofac Pathol J 2012;3:264-8.  Back to cited text no. 3
    
4.
Selvan A. Granuloma Gravidarum – The pregnancy tumor of gingiva. Int J Med Dent Homeopath Nurs 2016;1:12-5.  Back to cited text no. 4
    
5.
Regezi JA, Sciubba J, editors. Oral Pathology, Clinical-Pahological Correlations. 2nd ed. Philadelphia: W.B. Saunders; 1993. p. 196-202.  Back to cited text no. 5
    
6.
Bodur S, Özcan E, Gun I. Periodontological disease of pregnancy: Pregnant tumor. Perinat J 2011;18:55-8.  Back to cited text no. 6
    
7.
Sareen S, Baburaj MD, Pimpale S. Pregnancy tumor: Case report of two cases. IJSS Case Rep Rev 2015;2:14-8.  Back to cited text no. 7
    
8.
Garcia RI, Henshaw MM, Krall EA. Relationship between periodontal disease and systemic health. J Periodontol 2000 2001;25:21-36.  Back to cited text no. 8
    
9.
Srivastava A, Gupta KK, Srivastava S, Garg J. Effects of sex hormones on the gingiva in pregnancy: A review and report of two cases. J Periodontol Implant Dent 2011;3:83-7.  Back to cited text no. 9
    
10.
Panat SR, Agarwal A, Rajput R. Pregnancy tumor. J Dent Sci Oral Rehabil 2011;6:39-40.  Back to cited text no. 10
    
11.
Shah N, Raval P, Vyas N, Dudhi B. Pregnancy tumor of a 22-year-old female. J Ahmedabad Dent Coll Hosp 2010;1:39-42.  Back to cited text no. 11
    
12.
Kornman KS, Loesche WJ. The subgingival microbial flora during pregnancy. J Periodontal Res 1980;15:111-22.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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