An Unusual Case of Peripheral Ossifying Fibroma of the Mandible in an Adult Male

Peripheral ossifying fibroma is a benign reactive swelling of the gingiva, most commonly affecting young adults. It is said to be derived from cells of the periodontal ligament and is usually termed as a reactive hyperplasia. There has been considerable confusion in the terminologies used to describe this lesion; until it was separated from peripheral odontogenic fibroma in a recent WHO classification. It is sometimes also called as the peripheral cemento-ossifying fibroma but is quite distinct from the central cemento-ossifying tumour of bone. 

Peripheral ossifying fibroma is a frequently encountered lesion that represents 1-3% of all oral biopsies in most cases. It is rare in paediatric patients in relation to primary dentition and frequency reduces after the age of 30 years. Its incidence increases in the adolescent years. It is seen commonly in females suggesting a hormonal influence in its development. Trauma or irritation caused by dental prosthesis or restorations, plaque or calculus, is said to play a role.

Peripheral ossifying fibroma occurs predominantly on the gingiva, specifically developing in the interdental papilla. It is seen commonly in the maxilla especially in the anterior area; the most common site being the incisor/ cuspid area.

Clinically, it is difficult to differentiate this lesion from other growths on the gingiva, such as the irritation fibroma, peripheral giant cell granuloma, pyogenic granuloma, and the giant cell fibroma. Radiographs rarely show bone involvement. The histology is characteristic, with the presence of either cementum or bone or calcium deposits in a cellular connective tissue stroma. The treatment for peripheral ossifying fibroma is complete excision and elimination of the causative factor. The recurrence rate is high hence the lesion is kept under observation.

The case report of a 40-year-old male patient who had a growth that had a normal overlying surface mucosa and of firm consistency, in the anterior portion of his lower jaw, has been reported here. Histological features were confirmatory for a peripheral ossifying fibroma