Peripheral ossifying fibroma mimicking gingival ulcer: case report

Peripheral ossifying fibroma (POF) is a non-neoplastic lesion, of uncertain aetiology, that originates from the gums or interdental papillae of the anterior maxilla. . It is most prevalent in the anterior maxilla –in women in the second and third decades of life. The lesion is well-defined with a sessile base and a surface similar in colour to mucosa or red, which may be intact or ulcerated. Clinical features do not confirm the diagnosis of this lesion, which requires histopathology. Our patient - B.M.S, a 23-year-old woman sought help of the Symptomatology Clinic at the School of Dentistry of the Federal University of Paraná, complaining of a “cold sore in the gum” for approximately one month. Clinical examination showed an erythematous area with central ulceration in the gingival margin and attached to the buccal region of tooth 22. Periodontal examination showed absence of bleeding, a periodontal pocket and absence of bone loss in the radiographs. There were no relevant findings in the auxiliary studies. Excisional biopsy was taken and the histopathological examination revealed the presence of dense fibrous stroma of collagen fibres, intermingled with fibroblasts, trabecular bone and a few giant cells, confirming the diagnosis. There was recurrence of the lesion. Surgical excision of the recurrent lesion was performed, including the removal of the periosteum and ligament, accompanied by dental scaling. It was concluded that further differential diagnosis was necessary to rule out clinically similar lesions to POF such as fibrous hyperplasia, peripheral giant cell granuloma and pyogenic granuloma. These lesions can mimic ulcers and therefore it is necessary to conduct histopathological examination to make the diagnosis. Furthermore, in order to minimize the tendency of recurrence of POF, it is essential to remove the underlying periosteum and periodontal ligament in addition to biofilm and calculus.