Ossifying Fibroma

What is an ossifying fibroma?

An ossifying fibroma is a rare noncancerous (benign) tumor made of bone tissue that forms within connective tissue. These slow-growing tumors most commonly affect bones in your face, especially the jawbones.

An ossifying fibroma is a type of fibro-osseous lesion (FOL) that affects your head or neck. Lesions like ossifying fibromas occur when fibrous tissue that contains a bone-like substance replaces healthy bone.

What do the terms “ossifying” and “fibroma” mean?

You may better understand this condition when you break down the definitions of each word.

• Ossifying is the medical term for changing into bone. With ossifying fibroma, bone develops within fibrous connective tissue where it doesn’t belong. Your bones and connective tissues are part of your musculoskeletal system.
• Fibroma refers to the fibrous tissue that makes up the tumor. Healthcare providers use the suffix “-oma” to refer to all tumors, regardless of whether they’re cancerous (malignant).

What are the types of ossifying fibromas?

There are different types of ossifying fibromas:

• Cemento-ossifying fibroma: Most healthcare providers simply call this type ossifying fibroma. The tumor forms within the hardened layer of connective tissue called cementum that covers the root of a tooth. This tissue secures teeth to the lower jaw (mandible). A fibroma can cause facial swelling and tooth loss. This type most commonly affects women and people assigned female at birth (AFAB) in their 30s or 40s.
• Juvenile ossifying fibroma: This faster-growing, more aggressive tumor tends to occur in children ages 5 to 15. It can affect any part of a child’s skull.
• Peripheral ossifying fibroma: This tumor develops between teeth on the upper jawbone (maxilla). It mostly affects adolescents and young adults.

What causes ossifying fibromas?

Medical experts aren’t sure why some people develop ossifying fibromas. Potential causes may include:

• Build-up of dental plaque.
• Gum irritation.
• Trauma to the face or jaw.
• Dental procedures.

What are the symptoms of ossifying fibromas?

Ossifying fibromas are rarely painful. Most people don’t have symptoms. You may find out you have this tumor after getting an X-ray as part of a dental check-up or an imaging test to check for a different problem.

When symptoms occur, they vary depending on the type:

• Cemento-ossifying fibromas: Facial swelling (edema) and shifting of teeth.
• Juvenile ossifying fibroma: Bulging eyes and nasal congestion.
• Peripheral ossifying fibromas: A red bump (mouth ulcer) on the upper gum or swollen gums.

How is an ossifying fibroma diagnosed?

Your dentist may notice an ossifying fibroma on a dental X-ray. You may also get more detailed imaging scans like a CT scan or an MRI. A biopsy of the tumor is the only way to make a definitive diagnosis. This biopsy typically occurs after surgery to remove the tumor.

How are ossifying fibromas treated?

An oral (dental) surgeon like an endodontist surgically removes ossifying fibromas. Your provider will send the tumor to a lab to biopsy it and confirm the diagnosis. If the tumor is large, you may need a bone graft to replace missing bone.

What are the complications of ossifying fibromas?

An untreated ossifying fibroma can grow large and take the place of healthy bone. This increases your risk of a facial fracture. Tumors in the jaw can lead to reabsorption of the roots of your teeth, causing your teeth to move.

Can you prevent ossifying fibromas?

Ossifying fibromas are rare. Because medical experts aren’t sure why some people develop these tumors, you can’t prevent them.

What is the outlook for someone with an ossifying fibroma?

An ossifying fibroma can grow back months or years after surgical removal. Children are more likely to experience a tumor recurrence. Your healthcare provider will schedule regular follow-up appointments for up to 10 years after surgery to check for signs of tumor regrowth.

Recurrence rates vary depending on the type:

• Cemento-ossifying fibromas: Almost 30% recurrence rate.
• Juvenile ossifying fibroma: 30% to almost 60% recurrence rate.
• Peripheral ossifying fibromas: Up to 20% recurrence rate.

When should I call the doctor?

Call your healthcare provider if you experience:

• Chronic nasal congestion.
• Facial swelling or pain.
• Swollen or irritated gums.
• Red bumps on gums.

What should I ask my provider?

You may want to ask your healthcare provider:

• What caused the ossifying fibroma?
• What is the best treatment?
• Should I look for signs of tumor recurrence or complications?

Can an ossifying fibroma become cancerous?

No. It’s rare for a benign bone tumor to become cancerous. And there’s no evidence of an ossifying fibroma ever being anything but benign (not cancer).

What is the difference between an ossifying fibroma and a non-ossifying fibroma?

An ossifying fibroma and a non-ossifying fibroma are both benign bone tumors that occur for no known reason. There are some key differences:

• A non-ossifying fibroma won’t turn into bone material (ossify). These tumors usually form on the long bones in children’s legs. They rarely cause problems or require treatment. A non-ossifying fibroma typically goes away when a child’s bones stop growing.
• An ossifying fibroma hardens (calcifies) into bone or bony material. People of any age can develop an ossifying fibroma. These tumors usually affect facial bones, especially the jawbones. They can grow large and cause teeth to shift. They almost always require treatment.

A note from Cleveland Clinic

Most ossifying fibromas form in your jawbones or facial bones. Even though an ossifying fibroma isn’t cancerous, you still need surgery to remove the tumor. An untreated tumor may start to replace healthy bone, increasing your risk of fractures and dental damage. An oral surgeon can remove the tumor and perform ongoing X-rays to check for tumor regrowth.