A patient with a long-standing prosthesis presents for removal, and upon examination, you find 'pebble-like' nodules in the bearing area beneath the prosthesis. What is the most likely diagnosis?

Correct answer: D. Papillary hyperplasia

• A. INCORRECT — Epulis fissuratum presents as folded, flap-like fibrous tissue at the denture border, not as pebble-like nodules under the denture.
• B. INCORRECT — Denture stomatitis (Type I, II, or III) overlaps with candidiasis and presents as inflammation, but the pebble-like description specifically points to papillary hyperplasia.
• C. INCORRECT — Candidiasis (denture stomatitis) presents as erythema (redness) and may have a velvety/granular texture but not distinct 'pebble' nodules.
• D. CORRECT — Papillary hyperplasia (inflammatory papillary hyperplasia) presents as multiple small, pebble-like or cobblestone-like nodular projections in the hard palate or denture-bearing area, associated with chronic denture wear, especially if the denture is worn 24 hours/day or is ill-fitting.