Objective: The study emphasizes on the features which lead to diagnostic complexities of localized reactive hyperplastic lesions (LRHL) in clinical settings thus making histolopathological examination imperative for definite diagnosis. Materials and Methods: A total of 314patients presenting with reactive hyperplastic lesions in out-patient department of University College of Dentistry from June 2012 to January 2015 were included in the study. After provisional diagnosis, lesions were excised and specimens were submitted for definite histopathological diagnosis. Descriptive statistics and Chi-square test was applied using SPSS version 20.0. Results: Most common age group was 30-39 years (n=147, 50.6%) with male to female ratio of 1:3. Most affected site was maxillary gingivae (n=140, 49.3%) while poor oral hygiene (n=152, 52.4%) was most frequent aetiological factor. Provisional diagnoses included pyogenic granuloma (PG) with maximum number of cases (n=141, 45%) followed by focal fibrous hyperplasia(FFH) (n=118, 37%), peripheral giant cell granuloma(PGCG) (n= 34, 11%) and peripheral ossifying fibroma (POF) (n=21, 7%). After definite diagnosis, the order of occurrence of LRHL remained the same but the number of cases of each individual lesion carried a significant discrepancy with 157 histopathologically proven cases of PG (50%) followed by FFH (n=111, 36%), PGCG (n=29, 9%) and POF (n=17, 5%) respectively. Conclusion: Variations in subjective assessment of LRHL could be lessened if histopathological examination is incorporated as a mandatory component in diagnostic protocol. Oral hygiene maintenance may also significantly improve the status of oral health and diminish possible chances of development of pathologies.