Pregnanacy Tumor

7/23/2019 Pregnanacy Tumor

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1)Review category

2)Angiogranuloma / Oral Pregnancy Tumor

3) Authors

First Author:

Dr!anu"a ! #a$havan

!enior %ecturer&De"artment o' Perio$ontics

!ree An(aneya nstitute o' Dental !ciences

#o$a**allur& +erala ,-.331

!econ$ Author:

Dr !ameer Punathil

Associate Pro'essor& De"artment o' Pe$o$ontics


#o$a**allur& +erala, -.331

Thir$ author

Dr !ha0na #oyin

Associate Pro'essor& De"artment o' onservative Dentistryn$o$ontics


#o$a**allur& +erala, -.331



4) A$$ress 'or corres"on$ence

Dr!anu"a ! #a$havan

!enior %ecturer&De"artment o' Perio$ontics

!ree An(aneya nstitute O' Dental !ciences

#o$a**alur,-.331

mail A$$ress:sanu56-7yahoocom

Phone no:8388949



A0stract

Gingival enlargement in pregnancy is called angiogranuloma or pregnancy tumor.It is a

conditioned gingival enlargement. It occurs when the systemic condition distorts the usual

gingival response .Presence of plaque is not the determining factor of the clinical feature.

Pregnancy accentuates the gingival response toward the local irritants. This review provides a

discussion regarding the causative factors, histopathology and management of pregnancy

tumour.

+eywor$s : Pregnancy, conditioned enlargement, altered tissue metabolism, hormonal

variation,subgingival micro flora

ntro$uction

Gingival enlargement or gingival overgrowth is the accepted current terminology for increase

in size of gingival which is a common feature of gingival disease. The term pregnancy

tumour was first coined by lum in !"!#.! The first report of PG in $nglish literature was

described by %ullihen in !&'', but the term (pyogenic granuloma) or (granuloma

pyogenicum* was introduced by %artzell in !"+'. # In the past (hypertrophic gingivitis

(or (gingival hyperplasia were the terms used for describing a clinical condition -ther

names of pregnancy tumor are Pyogenic granuloma, $uberant Granulation tissue,

Granuloma Gravidarium, /ngiogranuloma, Pregnancy $puli !

Pregnancy associated gingivalenlargement is included under the category of conditioned enlargements. 0onditioned

enlargement occurs when the systemic condition of the patient eaggerates or distorts the

usual gingival response to dental plaque. 1 /lthough there is considerable debate about the

incidence and causation of gingival changes during pregnancy, it is generally accepted that

increases in gingival inflammation typically begin in the second month and reach a maimal

level during the eighth month of pregnancy.'

In !"'2 3is4in and 5ess compiled a clinical classification of pregnancy gingivitis as follows:

0lass I 0haracterized by bleeding gingiva with more or less, no other

manifestations.

0lass II, 0haracterized by changes in the interdental papilla6oedema and

swelling with subsequent blunting of interdental papilla.

0lass III, 0haracterized by involvement of the free gum margin, which

ta4e on the color and general appearance of a raspberry.

0lass I78 Generalized hypertrophic gingivitis of pregnancy

0lass 7 8 The pregnancy tumor



nlargement in Pregnancy

The changes may be localized or generalized. /nother classification is marginal enlargementand tumor li4e gingival enlargement .The enlargement is usually noted on the marginal,

gingival and interdental papilla. 9

#arginal nlargement

The incidence has been reported !+ and ;+.The enlargement is generalized in nature and

more prominent interproimally than on facial and lingual surfaces. The enlarged gingiva is

bright red or magenta in color, consistency is soft and friable with a smooth shiny surface and

a tendency for spontaneous bleeding on slight provocation.

Tumor li*e ;ingival nlargement

This is a non neoplastic condition. The presence of bacterial plaque and the inflammatory

response toward the bacterial plaque is the cause for the enlargement.

The incidence rate is !.& to 9 . 2 The lesion appears as discrete ,mushroom li4e , flattened

spherical mass which protrudes form the gingival margin or from the interproimal space It

has either sessile or a a pedunculated base. The color usually appears as dus4y red or magenta

and numerous deep red pinpoint mar4ings could be noticed.The consistency usually is semi

firm .The condition is usually painless until it is accentuated by local factors or occlusal

interference which may lead to painful ulcers.

<isto"athology

It is a non specific, vascularising and proliferating inflammation. ; 0onnective tissue with

newly formed and engorged capillaries lined by cuboidal epithelial cells. The stratified

squamous epithelium is thic4ened, with prominent rete pegs and prominent intercellular

bridges and leu4ocytic infiltration.It is histologically similar to a pyogenic granuloma but it is

a distinct lesion on the basis of etiology, biologic behaviour, and treatment protocol.&

#anagement

The need for surgical intervention during pregnancy should be carefully eamined and the

possibility of regression after childbirth, due to the normalization of hormonal levels."

<urgical ecision and removal of the local irritants are the usual treatment indicated .In

certain cases the ecision might need to etend beyond the periosteum in order to prevent

reccurence.Presently soft tissue laser can be used for the ecision of the gingival tumor

because of the lower ris4 of bleeding when compared to scalpel method.

<urgical ecision of the lesion after delivery seemed the best treatment option. The

ma=ority of cases are symptomatic and show bleeding> nodules ?;!."@ with soft

consistency ?2#.1@ and a red surface ?;1.#@.<imple ecision is enough to preventrecurrence but the aetiology and pathogenesis must be 4nown to understand its nature.



The 5d:A/G laser is used nowadays because of the lower ris4 of bleeding compared

to other surgical techniques.!+

Discussion

In general accepted cause for pregnancy tumor is that the hormonal level that increases in

gingival inflammation typically begin in the second month and reach a maimal level during

the eighth month of pregnancy.This may lead to edematous erythematous and hyperplastic

gingival. The classic wor4 of Bornman C Doesch ?!"&+@ have reported that the subgingival

flora changes to a more anaerobic flora as pregnancy progresses.!! -E5eil ?!";"@ suggested

that the altered tissue response to plaque is due to depression of the maternal T lymphocyte. 9

-ne proposed eplanation of the causation of pregnancy gingivitisEE is that changing

hormonal levels cause the gingival inflammation. The fluctuation of hormonal level occurs

between the second month and reaches its pea4 at the eighth month. /fter the eighth month

the gingival inflammation will decrease due to the decrease in the hormonal level. 0apillary

dialation is said to be one cause for the increase in gingival inflammation.

Fatthiesen et al. reported systemic suppression of maternal immune systems, specifically an

altered Tcell response, and impaired lymphocyte proliferation was found. /n in vitro study

conducted by $hring etal suggested that the progesterone concentration found in placenta

bloc4s the B channel and this inturn contributes to maternal immunosuppression. It has been

proposed that, in the absence of 7$G, /ngiopoietin6# ?/ng6#@ causes blood vessels to

regress. The protein level of /ng6# was highest in the pregnancy tumors, followed by those

after parturition and normal gingiva. The amount of 7$G was high in the granulomas in

pregnancy and almost undetectable after parturition.

!ummary an$ onclusion

/ngiogranuloma is a type of conditioned gingival enlargement.The three types of conditionedgingival enlargement is hormonal, nutritional and allergic. The increase in Prevotella

intermedia in the subgingival microflora is one of the significant finding. %ormonal variation

is another important factor in the occurrence of pregnancy tumor

The presence plaque deposits and the factors that favour in the occurrence and recurrence of

the condition should be eliminated.



Re'erences

!.Hegezi /, <ciubba ?eds@: -ral Pathology, 0linical6Pahological0orrelations, #nd edition.

Philadelphia> J <aunders. !""1> !"26#+#

#. <hailesh F. Gondiv4ar ,,/mol Gadbail,, Hevant 0hole .-ral pregnancy tumor.0ontemp

0lin Kent. #+!+ ul6<ep> !?1@: !"+8!"#.

1. 5ewman,Ta4ei,Blo44evold,0arranza.0aranzas 0linical Periodontology. !+th ed:1&+L

'. %asson $. Pregnancy gsingivitis. %arefuah !"2+: 9&: ##'8##2.

9.

Haul I. Garcia,Fichellem. %enshaw C $lizabeth /. Brall. Periodontology #+++, 7ol. #9,

#++!, #!812

2. 5ewman,Ta4ei, Blo44evold,0arranza .0aranzaEs 0linical Periodontology. !!th ed:!#'

;. Kilip G 5aya4,/shita Mppoor,Fahesh 0 P.Tetboo4 of Periodontology and

Implanatology.#+!+.! st ed:!9&

&. Faier /J, -rban . .Gingivitis in Pregnancy. -ral <urg!"'">#:#1'

". Torgerson HH, Farnach FD, ruce /, Hogers H< 1rd. -ral and vulvar changes in

pregnancy. 0lin Kermatol. #++2>#'?#@:!##8!1#.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Gondivkar%20SM%5Bauth%5D

http://www.ncbi.nlm.nih.gov/pubmed/?term=Gadbail%20A%5Bauth%5D

http://www.ncbi.nlm.nih.gov/pubmed/?term=Chole%20R%5Bauth%5D

http://www.ncbi.nlm.nih.gov/pubmed/?term=Gadbail%20A%5Bauth%5D

http://www.ncbi.nlm.nih.gov/pubmed/?term=Chole%20R%5Bauth%5D

http://www.ncbi.nlm.nih.gov/pubmed/?term=Gondivkar%20SM%5Bauth%5D



!+.Powell D, ailey 0D, 0oopland /T, -tis 05, ran4 D, Feyer I. 5d: A/G laser ecision

of a giant gingival pyogenic granuloma of pregnancy. Dasers <urg Fed. !""'>!':!;&8&1

!!. Bornman B<, Doesch J. The subgingival microbial flora during pregnancy. Periodont

Hes !"&+>!9:!!!.

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Pregnanacy Tumor