Pyogenic granuloma occurring in a postmenopausal woman on hormone replacement therapy

Pyogenic granuloma is a benign nodular lesion occurring most commonly on the gingiva of females during periods of elevated sex hormones such as puberty and pregnancy. Possible molecular mechanisms responsible for the appearance of pyogenic granuloma in this demographic have been suggested. Increased incidence of pyogenic granuloma in post menopausal women on hormone replacement therapy has not been reported. A 49-year-old woman with preexisting titanium implant placement in the left posterior mandible presented with complaint of food impaction and slight discomfort associated with the implant. Clinical examination revealed slight soft tissue erythema and edema, but no foreign body could be identified. Subsequently, a nodular gingival lesion associated with the implant developed and was treated by conservative surgical excision. Histologic characteristics of the lesion were consistent with pyogenic granuloma. The patient was informed of the diagnosis. No evidence of recurrence could be identified after 6 months. Like peripubertal and pregnant women, postmenopausal women treated with hormone replacement therapy may be at increased risk for pyogenic granuloma. Observational studies designed to establish an association between hormone replacement therapy and pyogenic granuloma have not been conducted. Dentists should be aware of putative pathophysiologic mechanisms for pyogenic granuloma formation and the possibility that hormone replacement may trigger these mechanisms.