Gingival Enlargement Associated With a Partially Erupted Mandibular Molar 7/24/09

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Ray Murphy Date: 7/24/09 Region: Providence
Article title: Gingival Enlargement Associated With a Partially Erupted Mandibular Molar
Author(s): Catherine Flaitz, DDS,MS
Journal: Pediatric Dentistry
Volume #; Number; Page #s): 23:5, 3
Year: 2001
Major topic: Peripheral odontogenic fibroma (PodF)
Minor topic(s): -
Type of Article: Case Report
Main Purpose: Discuss the clinical and microscopic features of a PodF in a 13yo male.
Overview of method of research: 13yo male evaluated for soft tissue growth overlying his mandibular second molar.

Findings: A POdF is a rare tumor that exclusively exists in the soft tissues covering the tooth bearing areas of the jaws. It is described as a firm, sessile enlargement of the soft tissue with a pink, smooth, nonulcerated mucosal surface. They range in size from approx. .5cm-3.5cm. It is found throughout the dental arches with an affinity for the buccal gingival of the mandible. It typically presents as a solitary lesion. This 13 yo male patient presented with an asymptomatic fibrous overgrowth on his mandibular second molar. IOE revealed a 2cm x 1.5 cm firm, pinkish gray, smooth, dome shaped lesion arising from the posterior lingual gingival/retromolar pad. The lesion was delaying the second molar from fully erupting. Also, the maxillary second molar was displaced lingually into a cross-bite as a result of occluding on the lesion. Radiographically the second molar had normal root development and open apices. No bone involvement was noticed. EOE revealed multiple hypertrophic scars and keloids on the patients extremities. Treatment of the lesion was excisional biopsy to allow the second molar to completely erupt. Histologically, the lesion was comprised of well vascularized, fibrous connective tissue with multinucleated giant cells. There was no evidence of calcifications in the stroma. Ten months after the excision of the lesion there was no recurrence.

Key points in the article discussion: The POdF is an uncommon gingival tumor that is similar to the central odontogenic fibroma. Whether the lesion is a true neoplasm, or a reactive hyperplasia has not yet been decided. People of all ages are susceptible to PodF’s, with the largest occurrence being before the age of 20(although this may be underestimated b/c not an operculum are submitted for histological differentiation). Treatment of choice is surgical excision. While the prognosis of the lesion after excision is excellent, it’s behavior is not totally understood. Recurrence happens 38% of the time, usually within 1-4 years. It is suspected that recurrence following the first year after excision is due to incomplete removal of the entire lesion initially. Differential diagnosis is extensive, including reactive hyperplasias, hamartomas, neoplasms, irritation fibromas, POF, pericoronal hamartoma, etc. The most common gingival enlargement overylying a molar is focal fibrous hyperplasia of the operculum. The difference between an operculum and a PodF is that a PodF will hinder the complete eruption of the affected molar, an operculum does not.

Summary of conclusions: In conclusion, the PodF is a soft tissue lesion that can affect the eruption of whichever tooth it is associated with. The differential diagnosis are extensive, but a diagnosis can be narrowed down by thorough IOE and histological differentiation. Histologically, the PodF and the pericoronal hamartoma are extremely similar, which could possibly mean that they represent a clinical spectrum of the same disease, ESPECIALLY when it occurs in children. The treatment of choice is excisional biopsy to allow the affected molar to continue erupting. Following excision, normal eruption of the affected molar was noted in 95% of cases.

Assessment of article: Good article. Clinically relevant. Listed numerous differential diagnosis of PodF and why it was different. Overall a good case report.