Telangiectatic granuloma, traditionally known as pyogenic granuloma, is a benign vascular tumor that appears in the oral mucosa in response to irritant, inflammatory, or traumatic stimuli. This case has a strong academic focus and will be of interest to dental surgeons. Clinicians should be alert to any gingival overgrowth. We present the case of a 79-year-old patient with a profuse lesion on a gingival papilla. Complete excision was performed followed by a confirmatory pathology study. We review the terminology, semiology, etiopathogenesis, and incidence of the lesion. Soft tissue enlargements of the oral cavity often present a major challenge because they may be produced by a diverse group of pathological processes. A tumor-like growth may be the result of a variation in normal anatomic structures, inflammation, cysts, development anomalies, or a neoplasm. We propose a differential diagnosis with other entities based on histopathology, and stress the importance of close follow-up from the time of diagnosis until surgical treatment and resolution. This case report does not query the validity of pyogenic expression but somehow, it might be misleading. We conclude that, in our case, the term “telangiectatic” is more appropriate than “pyogenic.”