A patient who never removes the maxillary denture has a red, pebbly, granular palatal mucosa confined to the denture-bearing area. What is the likely diagnosis?

Correct answer: A. Inflammatory papillary hyperplasia

• A. Correct. Continuous denture wear plus poor hygiene and candidal colonisation produces this multinodular, papillary erythematous change of the hard palate — inflammatory papillary hyperplasia. It is benign and reactive.
• B. Erythroplakia is a velvety red patch with a high rate of dysplasia, but it is not confined to the denture outline and has no papillary texture.
• C. Median rhomboid glossitis is a rhomboid depapillated patch on the dorsum of the tongue, not the palate.
• D. Carcinoma would be expected to ulcerate, indurate and cross anatomic boundaries rather than mirror the denture outline exactly.

Note: First-line management is to stop nocturnal wear, disinfect the denture, and treat the candidiasis. Only tissue that persists after that is excised before a new prosthesis is made.