Content Dam Diq Online Articles 2016 07 16jul7bcsimmons Diagtx16pathcaset
Content Dam Diq Online Articles 2016 07 16jul7bcsimmons Diagtx16pathcaset
Content Dam Diq Online Articles 2016 07 16jul7bcsimmons Diagtx16pathcaset
Content Dam Diq Online Articles 2016 07 16jul7bcsimmons Diagtx16pathcaset
Content Dam Diq Online Articles 2016 07 16jul7bcsimmons Diagtx16pathcaset

Diagnosis and treatment for Breakthrough Clinical oral pathology case: No. 16

July 6, 2016
Last month, Breakthrough Clinical’s Editorial Director Stacey L. Simmons, DDS, presented the oral pathology case of a 50-year-old female who presented with what she thought was “an infection on one of my top right teeth.” Clinical assessment revealed a pink 6 mm raised firm mass of osseous tissue measuring 12 x 12 mm. Dr. Simmons gives the differentials, final definitive diagnosis, and reveals the outcome of this case.
Stacey L. Simmons, DDS, Editorial Director of DE's Breakthrough Clinical e-newsletter

This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.

Last month I presented the oral pathology case of a 50-year-old female who presented for a new-patient exam upon the recommendation of her general practitioner. Her CC: “My doctor said that I have an infection on one of my top right teeth.” She pointed to a raised mass of tissue in between teeth Nos. 4 and 5. Clinical assessment revealed a pink 6 mm raised firm mass of osseous tissue measuring 12 x12 mm.

Read the complete details of the case and view photos here.

Differentials:

  • Pyogenic granuloma
  • Hormonal tumor
  • Fibrous hyperplasia
  • Osteosarcoma
  • Chondrosarcoma
  • Metastatic carcinoma
  • Peripheral odontogenic fibroma

Final/definitive diagnosis: peripheral ossifying fibroma

Peripheral ossifying fibroma (POF) is considered to be part of the family of lesions that may be defined as “an increase in the size of an organ or tissue due to an increase in the number of its constituent cells, as a local response of tissue to an injury.” (1) POF, a benign overgrowth of gingival tissue, (1) is the most common form of odontogenic fibromas. (2) It is thought to be derived from the overlying gingival epithelium. It frequently contains calcified deposits of cementum (1) and, if significant enough, these calcifications may show up on radiographs with a slight radiopacity. Its location is most often found in the interdental papillae and often will separate adjacent teeth.

“Some 50% occur in patients between the ages of five and 25 years, predominantly female patients. Eighty percent occur anteriorly to the molars.” (1) Since the lesions are raised, they typically have an erythematous surface due to chronic irritation. Treatment is excision with the attempt to remove underlying attachment to the bone. Recurrence is rare at 13%–16%. (1)

In this particular case, the patient was referred to an oral surgeon for an assessment and biopsy. The lesion was removed and sent to pathology with a definitive diagnosis of peripheral ossifying fibroma (figures 1, 2, and 3). The gingival defect created by the removal of the fibroma was allowed to heal by secondary intention and will likely undergo a free gingival graft later to reconstruct the attached gingival margin. The patient managed well without complications.

Figure 1Figure 2
Figure 3


This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.

References

1. Wood NK, Goaz PW. Differential Diagnosis of Oral and Maxillofacial Lesions. 5th ed. St. Louis, MO: Mosby; 1997:130–143.
2. Sapp JP, Eversole LR, Wysocki GP. Contemporary Oral and Maxillofacial Pathology. St. Louis: MO: Mosby; 1997:140–141.

MORE PATHOLOGY CASES . . .
Stacey L. Simmons, DDS, is in private practice in Hamilton, Montana. She is a graduate of Marquette University School of Dentistry. Dr. Simmons is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. She is the editorial director of PennWell’s clinical dental specialties newsletter, DE’s Breakthrough Clinical with Stacey Simmons, DDS, and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. Dr. Simmons can be reached at [email protected].

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