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Peripheral ossifying fibroma - Oral Mucosal Lesion
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Peripheral ossifying fibroma - Oral Mucosal Lesion

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Contributors: Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
Other Resources UpToDate PubMed


The peripheral ossifying fibroma is a fairly common, benign reactive proliferation of fibrous tissue with metaplastic bone formation that occurs on the gingiva. It tends to occur in the second and third decade with a slight female (2:1) predilection. It is often seen on the maxillary facial gingiva involving the anterior teeth.
It is thought to be related to poor gingival and periodontal health where chronic inflammation causes differentiation of pluripotent cells to bone-producing cells that are native to the area.
It develops over weeks, months and years and is slow-growing.


D10.30 – Benign neoplasm of unspecified part of mouth

109788007 – Peripheral ossifying fibroma

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Differential Diagnosis & Pitfalls

Most other gingival nodules may look similar and are only different histologically.
  • The lobular capillary hemangioma (pyogenic granuloma) (either related or unrelated to pregnancy) is generally reddish-purple or dusky red.
  • The peripheral giant cell granuloma is also often dusky red or purple and may be associated with underlying cupping of the bone.
  • The gingival fibroma is firm, fibrous looking and may be located on the attached rather than marginal gingiva.
  • Some odontogenic cysts and tumors may occur on the gingiva but they are generally not located on the marginal gingiva but on the attached or non-attached gingiva.
  • The parulis (dental sinus tract) is usually located near the apices of teeth.
  • Metastatic tumors do occur as gingival nodules but these are generally rapidly growing and tend to occur in older individuals with a history of such a tumor.

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Last Updated: 10/31/2017
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Peripheral ossifying fibroma - Oral Mucosal Lesion
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Peripheral ossifying fibroma : Gingival-alveolar mucosa, Oral nodule, Gingival bleeding
Clinical image of Peripheral ossifying fibroma
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