The appearance of any sore or raised, irritated spot in the mouth can be troubling. Many of these however fall into a broad category of harmless oral granuloma. Here’s what causes these spots, symptoms, and how to treat them.
What is a granuloma?
A granuloma is defined simply as “localized nodular inflammation found in tissues.” This means it is not a widespread condition on the entire body. The most common locations for granulomas are in the:
- Upper torso
Because inflammation can be localized or concentrated anywhere, some people will experience oral granulomas in the mouth.
Oral granuloma are sometimes referred to a pyogenic granuloma or an oral pregnancy tumor. Both of these names are a nod to one of the main causes of granuloma: pregnancy (see below).
When do oral granulomas occur?
Oral granuloma can be found anywhere in the soft tissues of the mouth but are most often found at the gumline. Women are more likely than men to have them, and mostly very old people or children and young adults develop oral granuloma.
The causes of oral granulomas are not always clear, but there are a few factors that contribute to their development.
Trauma to the mouth can cause the formation of an oral granuloma. Why this occurs is unclear, but it could be related to the blood vessels in the traumatized area responding to the trauma.
The trauma does not need to be particularly traumatic, either. Even just a pinprick-sized breaking of the skin can help to develop granuloma.
Infection also contributes to the development of pyogenic granulomas. Staphylococcus aureus is frequently present in the lesion.
Viral infection (as opposed to a bacterial infection) is more of a hypothetical cause than one that is backed by much research. The presence of a virus, however, may contribute to the development of an oral granuloma, but it is not the sole cause.
Pyogenic granuloma sometimes develop as a reaction in patients on an oral retinoid (acitretin or isotretinoin) or a protease inhibitor.
This is not to say that patients on these medications will always develop granuloma symptoms, just that the use of them makes the possibility increase.
One of the main causes of oral granuloma (and the reason it mostly affects women) is fluctuating hormones. Pregnancy tumors in the mouth affect between two and ten percent of expectant moms. They are referred to as an oral pregnancy tumor, a pregnancy granuloma, or a pyogenic granuloma. These tumors are inflamed nodes of tissue that are caused most commonly by excessive progesterone levels in pregnancy.
As with other dental concerns during pregnancy, oral pregnancy tumors occur most frequently during the second trimester.
Taking oral contraceptives that increase progesterone levels may also increase your chances of developing oral granuloma. The presence of this hormone makes women more susceptible to this type of lesion anywhere on the body, including in the mouth.
What are granuloma symptoms in the mouth?
Granuloma symptoms in the mouth are generally occur in the area of the granuloma itself. Even though they rarely reach sizes of more than ½ inch, their location can cause difficulty with eating and speaking.
Some localized symptoms may include:
- Chickpea-sized lobe (with or without a stalk at the base)
- Red or purple lesions
- Soft to the touch (not firm)
- May resemble ground beef or a raspberry in texture
- Soreness (around the granuloma)
- Rapid growth over a short period of time
Oral granuloma have no pus, but they may crack and bleed if irritated. This will scab over and then repeat the cracking and bleeding process if the irritation continues. Bleeding occurs more easily in the earlier stages of oral granuloma. As they get older, they seem to become more fibrous and do not bleed as easily.
These symptoms can appear suddenly, but there is good news. Oral granulomas are benign. Because they can resemble some types of oral cancers, your doctor may recommend a biopsy, but actual oral granulomas are always non-cancerous.
How do you treat oral granulomas?
In many cases, oral granulomas do go away by themselves over a period of six to 18 months. This occurs when either the underlying condition changes (i.e., an expectant mother gives birth) or simply because the blood vessels are no longer feeding the granuloma itself. This is the best-case scenario, as the oral granuloma is less likely to reoccur if it goes away on its own.
During this time of waiting for the oral granulom