What are the other Names for this Condition? (Also known as/Synonyms)

• Ossifying Fibrous Epulis
• Peripheral Cemento-Ossifying Fibroma

What is Peripheral Ossifying Fibroma? (Definition/Background Information)

• Peripheral Ossifying Fibroma is a common benign tumor of the gums usually diagnosed during teenage and young adulthood. Due to its preference for females, experts believe that hormonal factors may play a role in its development. The tumor is also associated with mouth trauma caused by implants or dental procedures
• Peripheral Ossifying Fibroma presents many overlapping features with the more uncommon tumor, namely peripheral odontogenic fibroma, and it is important to distinguish between the two
• Even though Peripheral Ossifying Fibroma is typically benign, large-sized tumors may present discomfort, aesthetic problems, and loss of tooth/teeth. A simple surgical excision can be curative; however, the tumor is known to recur following treatment

Who gets Peripheral Ossifying Fibroma? (Age and Sex Distribution)

• Peripheral Ossifying Fibroma is observed in older children and adults (young and old). This oral cavity tumor is very uncommon in infants and young children
• Many tumors are diagnosed in teenagers and young adults; the incidence decreases after age 30 years
• Both males and females are affected, although a preference for females is noted (2:1 female-male ratio)
• Worldwide, there is no racial or ethnic preference observed

According to medical literature, between 1-3% of all tissue biopsies involving the mouth are Peripheral Ossifying Fibromas.

What are the Risk Factors for Peripheral Ossifying Fibroma? (Predisposing Factors)

The risk factors for Peripheral Ossifying Fibroma may include:

• Hormonal factors, since a greater number of cases are noted in females
• Mouth irritation or trauma caused by dental implants and oral procedures
• Presence of plaque under the gums

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Peripheral Ossifying Fibroma? (Etiology)

• The cause of formation of Peripheral Ossifying Fibroma is not well-understood
• It is believed to be a reactive process, and the tumor develops from minor trauma to the oral cavity region or from hormonal factors

Since the tumor frequently involves the gums, Peripheral Ossifying Fibroma is associated with the following gingival tumors:

• Giant cell epulis
• Pyogenic granuloma

According to some experts, the term Peripheral Ossifying Fibroma is a misnomer, since the tumor is neither a fibroma nor does it involve the bones.

What are the Signs and Symptoms of Peripheral Ossifying Fibroma?

The signs and symptoms of Peripheral Ossifying Fibroma may include:

• Appearance of a slow-growing firm mass on the upper jaw, typically above the incisor or canine teeth (on the outside). Some tumors form on the lower jaw
• Some tumors exhibit rapid growth, while many develop over months and years
• The upper lip may be projected outwards by the tumor
• The size of the tumor is typically below 2 cm
• It is often red-pink in color
• In many individuals, the gingival (gum) mass tends to ulcerate and bleed
• Large-sized tumors may cause pain, discomfort, and eating difficulties

How is Peripheral Ossifying Fibroma Diagnosed?

A diagnosis of Peripheral Ossifying Fibroma may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Oral cavity examination
• Tissue biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

A differential diagnosis is important to exclude other conditions/tumors presenting similar signs and symptoms. These include:

• Giant cell epulis
• Giant cell fibroma
• Oral irritation fibroma
• Peripheral odontogenic fibroma
• Pyogenic granuloma

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Peripheral Ossifying Fibroma?

The possible complications due to Peripheral Ossifying Fibroma include:

• Emotional stress from cosmetic issues and aesthetic appearances
• Superimposed bacterial and fungal skin infections
• Eating difficulties from large-sized tumor
• Displacement or loss of teeth
• Large tumors are known to invade into and destroy the jaw bone
• Recurrence of the tumor

How is Peripheral Ossifying Fibroma Treated?

The healthcare provider may recommend the following treatment measures for Peripheral Ossifying Fibroma:

• Minor surgery to remove the tumor
• Laser excision
• Tooth/teeth extraction is normally not required
• Antibiotic or antifungal therapy for secondary infections, if necessary

Regular follow up visits with the healthcare provider is important and recommended.

How can Peripheral Ossifying Fibroma be Prevented?

Presently, there are no preventative guidelines available for Peripheral Ossifying Fibroma. However, considering the following factors may help lower one’s risk for this oral cavity tumor:

• Plaque removal from beneath the gums
• Good oral hygiene
• Ensure dental prosthesis and implants fit properly and do not cause minor and repetitive oral trauma
• Undertake periodic and regular visits to a dental professional

What is the Prognosis of Peripheral Ossifying Fibroma? (Outcomes/Resolutions)

• The prognosis of Peripheral Ossifying Fibroma is generally good with appropriate treatment (surgery) of the condition
• However, recurrences have been reported in 1 in 5 cases, usually within a year of initial surgical removal of the tumor

Additional and Relevant Useful Information for Peripheral Ossifying Fibroma:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/dental-health/