DENTAL ANXIETY CAUSING DELAYED PRESENTATION OF BENIGN PATHOLOGY

Abstract

<h3>Background</h3> Peripheral ossifying fibroma is a benign gingival nodule, which is composed of a cellular fibroblastic connective tissue stroma with randomly dispersed foci of mineralized products, which consist of bone, cementum-like tissue, or a dystrophic calcification. It is usually caused by local irritation. It can be sessile or pedunculated with the size usually being less than 2 cm. <h3>Case Report</h3> A 60-year-old female patient was referred to the Oral and Maxillofacial Department on the 2 week-wait cancer pathway with regards to a large lump in the upper right quadrant. The patient reported the lesion had been present for over 5 years but recently started causing facial asymmetry and eating difficulties. She did not seek any advice previously because of severe dental anxiety. Examination revealed a large 3.5 × 3-cm erythematous and ulcerated pedunculated lesion in the posterior upper right quadrant. <h3>Results</h3> Surgical excision of the large growth in the upper right quadrant was performed under general anesthetic. Histopathology demonstrated a polypoid bony lesion showing extensive secondary changes with overlying ulceration, granulation tissue, and fibrosis. A diagnosis of peripheral ossifying fibroma was made. <h3>Conclusions</h3> Late presentation of benign intraoral lumps is more common in developing countries owing to lack of access, however, this case demonstrates that in developed countries severe dental anxiety can be a barrier in seeking early medical advice. It also demonstrates the possibility that late presenting benign lesions may present with atypical characteristics, mimicking that of malignant lesions, with histopathology being vital for diagnosis.