7/17/2009 Peripheral Ossifying Fibroma-a Clinical of 134 Pediatric Cases

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Ray Murphy Date: 7/17/09 Region: St. Joe’s

Article title: Peripheral Ossifying Fibroma-a Clinical of 134 Pediatric Cases
Author(s): Cuisia, E. et al.
Journal: Pediatric Dentistry
Volume #; Number; Page #s): 23:3
Year: 2001
Major topic: Peripheral Ossifying Fibroma(POF)
Minor topic(s): Differential Diagnosis of Soft Tissue Lesions
Type of Article: Clinical Evaluation

Main Purpose: To investigate the clinical features of POF’s in regards to the pediatric population.
Overview of method of research: Detailed clinical and historical information regarding 134 cases of POF’s in children from age 1-19. To evaluate the site occurrence of the POF’s, the maxilla and mandible both divided into three regions, incisor/cuspid, premolar, and molar.
Findings: A peripheral ossifying fibroma is characterized as a gingival nodule, made up of cellular fibroblastic connective tissue, consisting of mineralized products of bone, cementum, or dystrophic calcifications. In the pediatric population, POF’s have a large female predilection.95% of the POF’s were associated with a permanent tooth, or between a primary and permanent tooth. A primary tooth was involved in only 1% of cases(2 cases). The POF presented as a pinkish red, localized, smooth, exophytic lesion with a pedunculated base, ranging from .3cm-3cm in size, with the average being 1.2cm. Ulcers were present in 63% of the lesions. 60% of the lesions were found in the maxilla, with 57% in the incisor region. Etiological factors include local irritation(26%), Orthodontic treatment(7%), Trauma(7%), and unknown/unreported(59%). Only 1% of the cases reported the lesion as being painless. The rest either did not report, or reported no pain(24%). Duration of the lesion varied from two weeks to twenty five months, with two-24months being the norm(79%). Incidence of POF’s peak in the second decade of life, with a decreasing trend in older age groups. Also, there may be a higher incidence of POF’s in the African-American population. Treatment includes excisional biopsy or surgical excision, which should include total excision of the lesion, periosteum, and the affected PDL. Scaling and root planning of adjacent teeth is recommended. Extraction of adjacent teeth is usually not necessary. Of the 134 cases, ten had single recurrences, and one had multiple recurrences. The average time in between lesions was twelve months.

Key points in the article discussion: There were many key points in the article. POF’s have the highest incidence in the second decade of life. A POF in the first decade of life is very uncommon. POF’s are more common in females, and are usually found in the maxillary incisor/cuspid region. Follow up after surgical removal of a POF is highly recommended to monitor for recurrence. The main key point in the article was trying to determine why there is a predilection for POF’s with permanent teeth as opposed to primary teeth. If POF’s are etiologically derived from local irritation and trauma, why are more primary teeth not involved? The constant exfoliation of primary teeth should cause an increased number of POF’s in the pediatric population. The article surmised that there must be other factors must be present that are lacking in the pediatric population. According to this study, the dentist does not need to take radiographs for the differential diagnosis of a POF. This is in contrast to two previous studies. POF’s in children can exhibit large growth rates in short periods of time. Because of this, early diagnosis is important.

Summary of conclusions: A POF is a well defined lesion with various differential diagnosis, including peripheral giant cell granuloma, pyogenic granuloma, fibroma, and peripheral odontogenic fibroma. With regards to the pediatric population, occurrence in children and primary teeth is rare. When present, POF’s are mostly found in female ages 10-20 in the anterior maxilla. While a POF arising from the PDL of a primary tooth, or localized irritation associated with a primary tooth is possible, it is very uncommon. As previously stated, surgical excision or excisional biopsy is the treatment of choice, with close follow up.

Assessment of article: Overall it was a good article. Methods, results, and conclusions were clearly and concisely stated. There could have been more of a focus on figuring out why primary teeth are not affected as much as permanent teeth are. There was numerous differential diagnosis listed, along with the major sites and patient population who are affected by POF’s.