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Fibroma of the Gingiva: A Case Report of a 20 Year old Lesion

Article · December 2010

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Jazan University Sree Balaji Dental College and Hospital
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 CASE REPORT
Fibroma of the Gingiva: A Case Report of a 20 Year old Lesion

Mohammed Nazish Alam,1 S.C Chandrasekaran,2 Mohan Valiathan3

The 10 Most Common Soft Tissue Oral Lesions 7

ABSTRACT Entity Percentage of all oral lesions

Leukoplakia 18.2
Palatal or mandibular torus 17.2
Fibroma is a common benign tumor. It can occur at any age from
almost any soft tissue site the tongue, gingiva, and buccal mucosa
Inflammation or irritation 10.8
being the most common. Females are twice as likely to develop this
Irritation fibroma 7.4
benign tumor than male. Typically the lesion is a rounded, well-
Fordyce's granules 5.9
demarcated, variably sized mass attached to tissue by a stalk. The
Hemangioma 3.4
surface is smooth, and the color is slightly paler than the adjacent
Inflammatory ulcer 3.2
healthy tissue. It is usually characterized by a slow, painless growth
Papilloma 2.9
Epulis fissurata 2.6
accumulated over a period of months or years. Treatment usually
requires total excision and recurrence is rare.
Varicosities 2.1

General characteristics:
Key words: fibroma, soft tissue, benign tumor. 1. From acute or repeated trauma (poor healing;
exuberant scar tissue)
– May develop from pyogenic granuloma
– Most common soft tissue mass; 3rd most common
Introduction mucosal lesion in adults
– Prevalence: 12 lesions/1,000 adults
Fibroma is a common submucosal response to trauma
from teeth or dental prostheses and was first reported in 2. Gender Age Location :
1846 1,2 as fibrous polyp and polypus. It is universally – None (but 2x females for biopsied cases)
understood that the use of the term "fibroma" is not – 4th-6th decades
intended in this case to convey neoplastic origin, as is the – Buccal, lip, tongue, gingiva
usual intent of its use for fibrous tumors in other
anatomic sites. Found in 1.2% of adults, this 3. Smooth-surfaced, pink (normal color), painless
inflammatory hyperplasia is the most common oral nodule
mucosal mass submitted for biopsy and is usually – May be pigmented (racial pigment of surface
composed of Types I and III collagen. Gingival lesions are epithelium)
also common, although at that location they probably – May have surface frictional keratosis or traumatic ulcer
result from chronic infection rather than trauma. – Usually sessile, may be pedunculated
Its most common clinical aspect is the growth of well
4. Micro: dense, avascular fibrous stroma
delimited tissue, of a smooth surface, usually with
– No capsule
normal colored mucosa, sessile or pedunculated base, of
– Epithelium often atrophic
hard consistence 3, and smaller than 1.5 cm at its largest
– Small numbers of lymphocytes in fibrous stroma
diameter 4, though there have been reports of a 4-6 cm
injury 5. Its occurance is reported to the anterior 5. Usually grows to <1 cm. within 6 months; minimal
maxillary, more precisely in the interdental papilla 6. In increase after that
this case report the benign lesion is posteriorly – May become 3-4 cm.
positioned at the distal aspect of maxillary molar. – Does not go away
– No malignant transformation
107 IJCD • DECEMBER, 2010 • 1(3)
© 2010 Int. Journal of Contemporary Dentistry
6. Treatment : Conservative surgical excision
 CASE REPORT
6. Treatment : Conservative surgical excision

Case Description
A female patient aged 54 years reported with a
complaint of painless swelling in the upper left back
tooth region. The duration of the condition present was
more than 20 years. The condition present was causing
difficulty in mastication as the swelling regularly came
between the upper and lower teeth with regular
ulceration due to bite. Patient history revealed
condition was of long duration and and the patient
never felt that the associated teeth was mobile under
any circumstances. On intraoral examination the
swelling was located posterior to 16 and size was about
Figure 1 : Well Delimited Tissue, Smooth Surface, Normal
2.0 X 2.0 cm. It had the characteristic features like
Colored Mucosa
sessile or pedunculated base and normal mucosa colour
and hard in consistency (fig. 1).

Differential diagnosis
Periodontal abcess, Keloids, Pyogenic Granuloma,
Angiofibroma, Neurofibroma, Gorlin Syndrome
(Nevoid Basal Cell Carcinoma Syndrome), Epulis
Fissuratum, Squamous Cell Carcinoma Or Verrucous
Carcinoma
Investigation: Punch biopsy was taken and the tissue
was sent for histological examination, and was
diagnosed as fibroma.
Treatment : Under general anesthesia the lesion was
completely excised along with the periosteum using
scalpel and electrocautery and the lesion measured 2.0
Figure 2 : Surgical excision of the lesion along with the
X 2.0 cm with scaling and root planing of the adjacent
teeth. Follow up of the patient was done at regular periosteum to minimize the chances of recurrences
intervals and at the end of 2 months the area present
with fibroma has healed without any recurrences(fig 2).

Discussion
Fibroma is a slowly progressing lesion, the growth of
which is generally limited. Many cases will progress for
long periods of time like in this case it was for about 20
years before patients seek treatment because of the
lack of symptoms associated with the lesion. A slowly
growing pink soft tissue, sessile or pedunculated base
which was hard in consistency and was causing
difficulty in mastication and speech and also difficulty in
maintaining the oral hygine was present in the
posterior region which is rare literature has suggested
the presences of condition confined to anterior region
and usually associated to the interdental papilla .
Discussion and consideration of the various differential
diagnosis should be done tactfully to prevent
unnecessary distress to the patient and family. Zhang et Figure 3 : Unencapsulated, solid, nodular mass of dense and
8 hyalinized fibrous connective tissue that are arranged in haphazard
al noted that cancer was included in the differential
diagnosis in only 2% of cases. Treatment consists of fascicles. A mild chronic inflammatory infiltrate is present. The
surgical excision, including the periosteum, and scaling surface epithelium is hyperkeratotic, hyperplastic and ulcerated.
of adjacent teeth. Close postoperative follow-up is
IJCD • DECEMBER, 2010 • 1(3)
required because of the growth potential of of Contemporary Dentistry
© 2010 Int. Journal 108
incompletely removed lesions and the 8%–20%
recurrence rate 9.
 CASE REPORT

of adjacent teeth. Close postoperative follow-up is

required because of the growth potential of
incompletely removed lesions and the 8%–20% About the Authors:
recurrence rate 9.

References 1.Dr Mohammed Nazish Alam

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Email: dr.naz.ish.alam@gmail.com

IJCD • DECEMBER, 2010 • 1(3)

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