A long-standing complete denture is removed, revealing a pebbly, papillary red surface on the hard palate in the denture-bearing area. What is the diagnosis?

Correct answer: A. Inflammatory papillary hyperplasia

• A. CORRECT. INFLAMMATORY PAPILLARY HYPERPLASIA is a reactive proliferation of the palatal mucosa producing a characteristic pebbly, cobblestone, or granular red surface confined to the denture-bearing area. It is driven by ill-fitting or continuously worn dentures, poor denture hygiene, and superimposed Candida. It is NOT premalignant.
• B. Nicotinic stomatitis affects the hard palate of heavy pipe or cigar smokers, producing a diffusely WHITE palate with red dots (inflamed minor salivary duct orifices) — not a pebbly red surface under a denture.
• C. Torus palatinus is a bony, hard, midline exostosis covered by normal mucosa.
• D. Erythematous (denture) stomatitis produces flat, diffuse redness matching the denture outline, without the papillary architecture. It commonly coexists with papillary hyperplasia.

Note: Treatment sequence: remove the denture at night, treat the Candida, and improve hygiene. Only if the tissue does not resolve is surgical removal needed before relining or remaking the prosthesis.