Peripheral giant-cell granuloma

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 17, 2016
StartDiseasesPeripheral giant-cell granuloma

The gums of the mouth play an important role in maintaining oral health, so it is important to keep them healthy. A peripheral giant-cell granuloma can cause many issues. If a peripheral giant-cell granuloma is not treated in time, a patient can experience severe complications.

Contents

Definition & Facts

Peripheral giant-cell granulomas are lesions that appear on the tissue of the gingiva. These granulomas are an overgrowth of tissue that can gradually spread and damage surrounding teeth and bones of the jaw.

This type of granuloma is distinct from other lesions of the gums because it is comprised of giant cells that have multiple nuclei. It is the most common type of oral lesion, and occurs among many people. 60 percent of all peripheral giant-cell granuloma cases occur among women, and this condition is also more common among patients between the ages of 30 and 40. 

Symptoms & Complaints

Most of the symptoms of a peripheral giant-cell granuloma pertain to the appearance of the tissue overgrowth. It appears as a lump on the gums that is made up of soft tissue. The color is normally somewhat similar to the color of the gums, but a peripheral giant-cell granuloma can look somewhat redder or bluer than the surrounding area.

A granuloma can either appear smooth or bumpy on the surface. Instead of being perfectly round, the borders of a peripheral giant-cell granuloma are quite irregular. They grow rapidly and can sometimes bleed when stimulated.

Generally, peripheral giant-cell granulomas do not exceed two centimeters in diameter, but it is possible for them to become larger. They can grow between a gap in teeth to surround both the front and back portion of a gum.

It is more common for peripheral giant-cell granuloma to appear on the lower jaw (mandible), but they can also grow on the upper jaw (maxilla). If the peripheral giant-cell granuloma continues to grow without being treated, it can damage the jaw and cause the teeth fall out.

The damaged area of bone has a very distinct appearance referred to as saucerization because of its scooped shape. Though most peripheral giant-cell granuloma are not painful at first, they can cause severe pain after expanding to put pressure on the roots of the teeth and the jaw.

Causes

Most peripheral giant-cell granuloma are caused by some sort of trauma to the tissue of the gingiva. After a gum infection (gingivitis) or injury, the damaged cells do not always regrow correctly. Instead, it can sometimes cause a peripheral giant-cell granuloma.

The precise nature of the cells in a peripheral giant-cell granuloma is still not entire understood. Since these overgrowths are capable of breaking down healthy bones, they are most likely some type of osteoclast which is a bone cell capable of remodeling bones. The injury that often triggers a peripheral giant-cell granuloma's development may cause an overgrowth of damaging osteoclast cells.

The damage that can cause a peripheral giant-cell granuloma may be as mild as a slight scratch while eating a crunchy food item, or it may be from a severe cut or dental surgery. Other irritating factors include tooth fillings, dental prosthetics, plaque buildup, or gingivitis.

Though most patients get a peripheral giant-cell granuloma after damaging their gingival tissue, this is not always the case. In some instances it appears to develop spontaneously. Since peripheral giant-cell granulomas are more common among women in childbearing years, some researchers believe that it may have an underlying hormonal cause as well. 

Diagnosis & Tests

When a peripheral giant-cell granuloma is very small, it may not be noticed at first. However, once a bump is discovered by either the patient, a dentist, or a doctor, then the diagnosis process will begin. Diagnosing a peripheral giant-cell granuloma consists of ruling out other conditions and then determining the extent of the lesion.

A physical examination can usually identify that the bump on the patient's gum is not a basic cyst or sore. It will then be necessary to do a biopsy that removes a small portion of the granuloma. When examined underneath a microscope, the characteristic signs of the condition will be revealed. The cells of the lesion will consist of many giant cells with multiple nuclei clumped together into nodules. These giant cells are supported by oval and spindle shaped stem cells. The biopsy will also rule out any other tumor possibilities.

After the peripheral giant-cell granuloma is diagnosed, a doctor may recommend magnetic resonance imaging (MRI), X-rays, or other types of imaging tests. These can be used to see how deep the peripheral giant-cell granuloma has expanded into the underlying tissue of the gums.

Treatment & Therapy

Almost all cases of peripheral giant-cell granuloma will require a surgical treatment. Surgery for removing a peripheral giant-cell granuloma can often just be done with a local anesthesia to numb the mouth. The granuloma is then removed from the gum and bone. Any teeth surrounding the peripheral giant-cell granuloma will need to be completely cleaned with a scaling and root planing procedure to remove any lingering cells. If any portion of the peripheral giant-cell granuloma is left, it can regrow.

Even after a successful treatment, it is still possible for another peripheral giant-cell granuloma to appear in the same spot. Peripheral giant-cell granuloma has a recurrence rate of roughly 10 percent. Once the peripheral giant-cell granuloma is removed, further treatment may be needed to fix any of the side effects of the granuloma. If teeth were irreparably damaged, a dentist may need to remove them and install dental implants or prosthetics. Damaged jaw material will also need to be removed and then reconstructed. 

Prevention & Prophylaxis

It may be possible to greatly lower the risk of a peripheral giant-cell granuloma developing by practicing good oral hygiene and being very cautious.

To avoid any plaque buildup, gum disease, or cavities that could irritate the gums, patients should brush their teeth for at least two minutes twice a day and floss daily.

Anyone concerned about developing a peripheral giant-cell granuloma should also practice caution while eating and doing physical activities to avoid injuring their gums.