Pregnancy Tumors in the Mouth: Reassuring Birth Workers about Pyogenic Granuloma of Pregnancy
Ana is 26 weeks pregnant with her second baby when she calls her midwife in tears. For the past few weeks, she has noticed a red, “mushy” lump along her upper gum line. At first it just felt strange, but it has grown quickly. Now it bleeds with the slightest touch—when she brushes her teeth, eats, or even accidentally bumps it with her tongue. She has switched to soups and smoothies because chewing anything firmer leads to bleeding and discomfort. She is worried: “Is this cancer? Is it going to hurt my baby?”
Her midwife has seen this before and suspects a “pregnancy tumor”—the lay term often used for a pyogenic granuloma of pregnancy. With some reassurance and a timely dental referral, Ana learns that this is a benign, hormone-related growth that often improves after delivery. Understanding this condition can help birth workers respond calmly, reduce fear, and guide families to appropriate care.
What is a pyogenic granuloma of pregnancy?
Despite the scary name, a pyogenic granuloma is a benign, overgrown area of blood vessels and connective tissue—a reactive vascular lesion, not a true cancer or “granuloma” in the infectious sense. Modern pathology often classifies these lesions as lobular capillary hemangiomas.
When they arise on the gums during pregnancy, they are often called pregnancy tumor, granuloma gravidarum, or epulis gravidarum. These lesions are relatively common in pregnancy, with studies suggesting they occur in roughly 0.2–5% of pregnant women, particularly in the second and third trimesters.
They most often appear on the gingiva (gums), usually near the front teeth, but can also arise on the inner cheeks, lips, or tongue. They are typically:
Bright red or reddish-purple
Soft and “friable” (they bleed easily)
Dome-shaped or on a little stalk (pedunculated)
A few millimeters to a few centimeters in size
Because they are made up of fragile, newly formed blood vessels, even light trauma—brushing, chewing, or bumping the lesion—can trigger brisk bleeding.
Why do they happen in pregnancy?
Pregnancy is a pro-inflammatory, highly vascular state. Rising estrogen and progesterone levels change blood flow to the gums, alter the local immune response, and can make the gingival tissues more reactive to everyday irritants like plaque, tartar, or minor trauma.
Pyogenic granuloma of pregnancy is thought to arise when:
Hormonal changes (especially elevated estrogen and progesterone) increase vascularity and reactivity of the gums
Local irritants such as plaque, calculus, ill-fitting dental appliances, or minor trauma trigger a localized overgrowth of granulation tissue
Sometimes, pre-existing gingivitis or periodontitis is present and acts as a background irritant
Importantly, this process is localized to the tissue where the lesion forms. It does not indicate a systemic infection, a blood disorder, or a problem with the fetus.
The good news: prognosis is excellent
The most important message for birth workers to convey is that these lesions are benign. They do not turn into cancer and they do not harm the baby.
In many pregnant patients, oral pyogenic granulomas:
Appear during the mid- to late second trimester or third trimester
Reach a plateau in size
Regress significantly or even disappear completely in the weeks to months after delivery, once hormone levels fall
Because of this natural history, conservative management—watchful waiting plus improved oral hygiene—is often the first-line approach, especially if the lesion is small, not significantly symptomatic, and not suspicious for another diagnosis.
However, even a benign lesion can cause a lot of distress, especially if it:
Bleeds frequently
Interferes with eating, speaking, or brushing
Causes pain from repeated trauma
Has a worrisome appearance to the patient or family
These quality-of-life issues are where birth workers can play a crucial role in assessment, reassurance, and referral.
When should a pregnant client be evaluated?
Any new oral lesion that persists beyond 1–2 weeks deserves evaluation by a dental professional (dentist, periodontist, or oral and maxillofacial surgeon), especially if it is growing or bleeding easily. For suspected pregnancy pyogenic granuloma, encourage evaluation when:
The lesion is rapidly enlarging
Bleeding is frequent or difficult to control with gentle pressure
The client is avoiding solid foods because of pain or bleeding
There is significant anxiety about malignancy
The lesion looks atypical (e.g., irregular borders, mixed colors, large ulceration, very firm texture)
A clinical exam is usually sufficient to strongly suspect pyogenic granuloma. When there is diagnostic uncertainty—especially if the lesion has unusual features—a biopsy may be recommended to definitively rule out malignancies such as oral squamous cell carcinoma or other vascular tumors.
Typical management options
For most pregnant patients, management focuses on symptom control and prevention of further irritation:
Meticulous oral hygiene: gentle but thorough toothbrushing, flossing, and professional dental cleanings can reduce inflammation and plaque-related irritation.
Topical measures: some dentists may recommend antiseptic mouth rinses (such as chlorhexidine) for short-term use to reduce local bacterial load.
Avoiding trauma: using a soft toothbrush, modifying the brushing technique around the lesion, and avoiding sharp or abrasive foods that may nick the growth.
Surgical excision (often with simple local anesthesia) is an option when:
Bleeding is frequent or profuse
The lesion is large enough to interfere with nutrition, speech, or oral hygiene
There is uncertainty about the diagnosis
The lesion persists or worsens after delivery
Because these lesions are highly vascular and pregnancy itself increases bleeding risk, many oral surgeons and dentists prefer to defer elective excision until after childbirth, especially if the lesion is not severely symptomatic.PubMed Central+1 Emergency or urgent removal during pregnancy is usually reserved for situations where bleeding is difficult to control, there is significant nutritional compromise, or there is serious concern about malignancy.
Even after excision, recurrence can occur, particularly if the underlying irritant (for example, plaque buildup, calculus, or a rough dental restoration) is not addressed. Recurrence rates in general pyogenic granuloma series are around 15–16%.The Open Dentistry Journal+1 This is another reason why good oral hygiene and correcting local triggers are emphasized alongside any surgical treatment.
What birth workers can say and do
Birth workers are often the first professionals a pregnant person turns to when something unexpected appears in their body. Here are key ways you can support someone like Ana:
Normalize and reassure
You can explain, in simple language:
“This kind of pregnancy-related gum growth is almost always benign.”
“It is made of extra blood vessels in the gum tissue and often goes away after the baby is born.”
“It does not hurt the baby and is very different from oral cancer, although your dentist may still want to examine it closely or do a small biopsy to be sure.”
Your calm, confident tone can dramatically reduce fear, especially for clients who immediately jump to worst-case scenarios.
Encourage timely dental evaluation
Many pregnant individuals avoid dental care due to cost, fear, or misconceptions about safety. Birth workers can reinforce that:
Routine dental care is safe during pregnancy.
Evaluation by a dentist, periodontist, or oral surgeon is appropriate and important if there is a bleeding oral mass.
A dental professional can assess whether conservative care is enough or whether removal is needed now or best deferred until after delivery.
Offer practical tips for managing bleeding at home
For small episodes of bleeding that stop quickly:
Gently press a clean, damp piece of gauze or cloth against the lesion for several minutes.
Applying a cold compress to the outside of the face or sucking on ice chips can help constrict blood vessels and slow bleeding.
Advise clients to seek urgent care (ER or urgent dental evaluation) if:
Bleeding does not stop after 10–15 minutes of firm, direct pressure
Bleeding is heavy enough to soak through multiple cloths or gauze pads
They feel dizzy, lightheaded, or faint
There are signs of infection (increasing pain, swelling, or pus)
Protect nutrition, comfort and emotional well-being
If chewing solid food is difficult, encourage nutrient-dense soft foods and liquids—smoothies with protein, blended soups, yogurt, and soft cooked grains—while the client is awaiting dental evaluation. Validating the frustration and worry can be powerful: “It makes sense that this is upsetting—it looks dramatic and affects your eating. The good news is that we know what this likely is, and there are clear next steps to help.”
Coordinate postpartum follow-up
Because many pregnancy tumors regress within weeks after birth, it is helpful to:
Encourage a postpartum dental follow-up if the lesion is still present at 6–8 weeks after delivery
Remind the client that persistent lesions can be safely excised postpartum with lower bleeding risk and very good outcomes (PubMed Central+)
Closing the loop: back to Ana
In Ana’s case, her midwife reassured her that this sounded like a common benign pregnancy growth and helped her quickly schedule an appointment with a dentist experienced in managing oral lesions during pregnancy. The dentist confirmed the likely diagnosis of pyogenic granuloma of pregnancy, optimized her oral hygiene, and discussed options. Because the lesion significantly interfered with eating and caused repeated bleeding, a small, carefully planned excision under local anesthesia in the second trimester was recommended.
The procedure went smoothly, bleeding was controlled, and pathology confirmed a benign pyogenic granuloma. With improved comfort and less fear, Ana was able to return to normal eating, continue her pregnancy without additional oral issues, and focus on preparing for birth.
Key takeaways for birth workers
Pyogenic granuloma of pregnancy (pregnancy tumor, epulis gravidarum) is a benign, vascular overgrowth of gum tissue linked to pregnancy hormones and local irritation.
These lesions commonly appear in the second or third trimester, bleed easily, and can look alarming but do not harm the fetus or transform into cancer.
Many regress spontaneously after delivery, so conservative management with good oral hygiene and watchful waiting is often appropriate when symptoms are mild.
Referral to a dentist or oral surgeon is important when lesions are large, painful, interfere with eating or oral hygiene, bleed frequently, or have atypical features.
Birth workers are in a strong position to provide reassurance, promote safe dental care during pregnancy, support nutritional needs, and help families navigate decisions about timing of any procedure.
By recognizing pyogenic granuloma of pregnancy and understanding its benign nature, birth workers can turn a frightening experience into an opportunity for education, reassurance, and collaborative care.
