357 - The Fourth P? Peripheral Odontogenic Fibroma in a Pediatric Patient

Abstract:

Introduction: Peripheral odontogenic fibroma (POdF) is an extremely rare, benign, soft tissue tumor of odontogenic origin. It most commonly affects individuals between the fourth and fifth decades of life with a predilection for females. POdF presents exclusively on the gingiva as a fixed, firm mass either pink or red in color, typically on the mandible, with no significant radiographic changes. Clinically it cannot be differentiated from other gingival lesions, including peripheral ossifying fibroma, pyogenic granuloma, and peripheral giant cell granuloma. A definitive diagnosis is made upon histological examination of a biopsied sample due to noted scattered islands of inactive odontogenic epithelium.

Case Report: An 8-year-old male was referred to a private oral surgery practice for delayed eruption of tooth #3. Medical history indicated the patient was taking methylphenidate for ADHD and no known allergies. Clinical examination revealed hyperplastic tissue on the right posterior maxillary attached gingiva in the area of unerupted tooth #3. There were no ulcerations, erythema, or purulence. Radiographic findings revealed at least 75% of root development of unerupted #3. Contralateral tooth #14 was erupted and in full Class I intercuspal occlusion. An incisional biopsy was performed under general anesthesia due to patient’s ADHD and anxiety. Microscopic examination revealed scattered islands of inactive odontogenic epithelium in a fibromyxoid stroma, consistent with a diagnosis of POdF. This report explores the significance of POdF in pediatric patients, importance of diagnosis in this population including differential diagnoses, and recommended treatments.

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