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.