Peripheral Ossifying Fibroma — ORE Part 1 MCQ

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ModerateOral PathologyPeripheral Ossifying FibromaORE Part 1

A 30-year-old man presents with a painless, lobulated, pedunculated soft tissue mass on the gingiva between the lower left first and second premolars. It is the same colour as the surrounding mucosa and firm. Radiographs show no underlying bone involvement. What is the most likely diagnosis?

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Correct answer: E — Peripheral ossifying fibroma

The clinical presentation is characteristic of peripheral ossifying fibroma (POF): a painless, pedunculated, lobulated gingival mass in an interdental site with firm consistency and no radiographic bone involvement. POF is a non-malignant reactive lesion arising from periodontal ligament cells, typically presenting as a hard nodule ranging from pink to cherry red. The interdental location between lower premolars is a common site. Radiographs typically show no bone involvement unless recurrence occurs. Distractors: Peripheral giant cell granuloma is clinically similar but distinguished histopathologically by the presence of giant cells. Pyogenic granuloma is highly vascular with a tendency to bleed, presenting as red/purple, not the same colour as surrounding mucosa. Gingival carcinoma would present with pain, ulceration, and aggressive bone involvement. Lateral periodontal cyst is intraosseous and would appear as a bone radiolucency, incompatible with the clinical presentation described.

Reference: Clinico-pathological profiling of peripheral ossifying fibroma of the oral cavity. NCBI PMC8513507 (2022); The Management of Peripheral Ossifying Fibroma: A Case Presentation. NCBI PMC11531663 (2024), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8774310/