A red lump on the gum that bleeds whenever you brush can be unsettling, especially when it appears in the middle of a pregnancy and seems to grow by the week. In most cases it is a pregnancy epulis, also called a pyogenic granuloma or granuloma gravidarum: a harmless overgrowth of inflamed gum tissue. The old name 'pregnancy tumour' sounds frightening, but the lump is not a cancer and does not spread.
It is still worth having any new lump in the mouth checked, both to confirm what it is and because simple steps often make it smaller.
Hormones amplify the gums' reaction to plaque
Two things usually combine. The first is a local irritant, most often plaque or tartar along the gum line, or the rough edge of a filling. The second is the higher level of oestrogen and progesterone in pregnancy, which makes the gums react much more strongly to that irritant than usual. In a 2013 Brazilian retrospective study of 41 cases (Cardoso and colleagues, Journal of Applied Oral Science), a local irritant was found in about three quarters of lesions, and around half appeared in the third trimester.
The same lump can occur in people who are not pregnant, in response to irritation or a small injury. Pregnancy simply makes it more likely.
Recognising one
A pregnancy epulis is typically a soft, smooth or slightly lumpy swelling, deep red to purple, growing from the gum between two teeth. It is usually painless. Its most noticeable feature is how easily it bleeds, because it is made largely of fragile new blood vessels. A toothbrush, a crunchy piece of toast or even the tongue can set it off. Some grow over just a few weeks.
How common it is remains uncertain. A 2019 systematic review in the Journal of Oral Pathology and Medicine (Bett and colleagues) pooled studies of oral changes in pregnancy and found pyogenic granuloma in about 3 per cent of pregnant women, although the authors rated the quality of that evidence as very low.
Other lumps can look similar, including fibromas, other reactive gum growths and, rarely, more serious conditions. Our articles on oral fibromas and mouth lumps and on mucoceles and lip cysts describe some of these. Only an examination, and sometimes a biopsy, can tell them apart with confidence.
Cleaning comes before any thought of surgery
Because plaque feeds the inflammation, the first step is usually to take it away. That means a gentle professional clean by a dentist or OHT, and careful home care: brushing twice a day with a soft brush and fluoride toothpaste, and cleaning between the teeth once a day, including around the lump. It is natural to avoid a spot that bleeds, but leaving plaque there tends to keep the lump going. Gentle, regular cleaning usually reduces bleeding over time.
Bleeding gums are common in pregnancy even without a lump, and our guide to bleeding gums when brushing explains why. Healthdirect's advice is to see a dentist or OHT if gums still bleed after three to four days of good brushing and flossing.
Many settle after the birth
Pregnancy-related lumps often shrink once hormone levels fall after delivery, and some disappear without further treatment. For that reason, a small, stable lump that is not causing problems is often watched through the rest of the pregnancy and reviewed afterwards.
Removal becomes more likely if the lump bleeds heavily, interferes with eating or cleaning, keeps growing, or is still present some weeks after the birth. It is done under local anaesthetic, the base is removed along with any irritant such as tartar, and the tissue is usually sent for testing to confirm the diagnosis.
Lumps can return. In one large Brazilian series of 293 oral pyogenic granulomas (Gordón-Núñez and colleagues, Journal of Oral and Maxillofacial Surgery, 2010), about 8 per cent recurred. Recurrence is thought to be more likely when a lump is removed while pregnancy hormones are still high, or when the irritant is not fully dealt with, which is one reason removal is often delayed until after the birth when that is practical.
Dental care during pregnancy
Check-ups and cleans are safe during pregnancy and are encouraged. If treatment is needed, your dentist will plan it around how far along you are and your comfort in the chair. Gum health in pregnancy matters beyond the mouth too, as our article on gum disease and pregnancy outcomes explains.
A typical market range for a check-up and clean in Sydney is $200 to $400, depending on the X-rays and cleaning needed. Any removal would be quoted after an examination, and current offers are listed on our current deals page.
What patients ask about pregnancy gum lumps
Should I try to remove it at home?
No. Picking, cutting or tying off the lump can cause heavy bleeding and infection and does nothing about the cause. Have it looked at instead.
When should I be more concerned?
See a dentist promptly if a lump grows very quickly, bleeds heavily or will not stop bleeding with pressure, becomes painful, or looks ulcerated. As with any patch, ulcer or lump in the mouth, see a dentist or GP if it has not healed or changed within three weeks.
Can it affect my baby?
The lump itself is a local gum problem and is not known to harm the baby. Keeping the gums healthy during pregnancy is still worthwhile for your own comfort and oral health.
If you are pregnant and have noticed a lump or bleeding from your gums, the team at Lumi Dental in Melrose Park can check it and talk you through the options for the rest of your pregnancy. This article is general information and is not a substitute for an individual assessment.
