Peripheral Ossifying Fibroma - A Clinical Evaluation of 134 Pediatric Cases.

Resident: Adam J. Bottrill
Date: 22DEC10
Region: Providence
Article title: Peripheral Ossifying Fibroma - A Clinical Evaluation of 134 Pediatric Cases.
Author(s): Elvira S. Cuisia Zenaida
Journal: Pediatric Dentistry
Page #s: 245-248
Vol:No Date: 23:3 2001
Major topic: Peripheral ossifying fibroma
Minor topic(s): NA
Type of Article: Clinical Evaluation

Main Purpose: This study, the first devoted to children, investigated the clinical features of a large number of POF's and compared the findings to cases reported in the English language literature.




Key points in the article discussion:

I. General:

A. Solitary gingival enlargements common in children. Usually due to irritation.
B. Peripheral Ossifying Fibroma:
1. Gingival nodule, cellular fibroblastic connective-tissue stroma with dispersed calcified foci.
2. Localized, exophytic lesion with sessile or peduculated base.
3. Most studies on POF's concentrate on the entire category of "fibroma's". Also, there are NO studies on POF's in the pediatric population.
4. Reactive lesions like POF do have pediatric significance that require early recognition and treatment by a dentist.
5. Definative etiology unknown
6. DD: Pyogenic Granuloma, Fibroma, Peripheral giant cell granuloma, irritation fibroma, papilloma, peripheral odontogenic fibroma

II. Methods:

A. Clinical and historical information of 134 surgically-removed POF's in patients age 1-19.
B. Clinical Manifestations, histogenesis, treatment rationale, biological behavior were emphasized.
C. 657 POF's in the 43362 biopsies during the study period. Only 134 (20%) were pediatric patients.

III. Results

A. Females (60%)
B. Maxillary Gingiva (60%)
C. Incisor/cuspid region
D. Average age 14yo (6mo to 19yo)
E. 71% of cases were found in black pts. (MAY indicated increased incidence)
F. Color: pink to reddish
G. 63% of lesions were ulcerated.
H. Size: 0.3 - 3.0 cm
I. Only 2 (1%) associated with primary teeth.
J. Clinician RARELY included POF in DD.
K. Recurrence rate after excision 8% (vary from 7-46% depending on the study)
1. This 8% may be inaccurate due to the nature of this study. There was no attempt to determine the recurrence rate of patients who did not follow up.

VI. Conclusions

A. Must consider taking radiographs, even for soft tissue lesions such as POF in order to determine the extent of the lesion and eliminate the DD.
B. POF is a well-defined pathologic entity among reactive gingival lesions.
C. Peak incidence is in the 2nd decade. Incidence of POF in 1st decade is very uncommon.
D. POF most common in female.
E. POF found mostly in maxillary incisor region.
F. POF arising from PDL of primary tooth uncommon.
G. Proper treatment protocol is warranted with close follow-up.

Assessment of article: Informative. Large "n". The author attempts to tag this study as somewhat "ground-breaking" by mentioning it's the first PEDIATRIC study of it's kind. I suppose it's interesting, but I don't see it changing the way I treat patients. The conclusions were appropriate. Medium Likey.