A patient with a newly delivered metal framework RPD returns with redness, soreness, erythema, and pain specifically under the major connector. What is the MOST likely diagnosis?

Correct answer: A. Allergic reaction to the metal framework

• A. Correct. Redness, soreness, and erythema SPECIFICALLY UNDER THE METAL MAJOR CONNECTOR of a newly delivered RPD, with no other areas affected, is MOST likely an ALLERGIC REACTION (contact hypersensitivity Type IV) to the metal framework (often nickel or other alloy components). This presentation — location matching the metal contact — is classic for metal allergy.
• B. Incorrect. Candidal denture stomatitis typically occurs under the ACRYLIC base of complete dentures, not specifically under a metal major connector in a newly delivered RPD.
• C. Incorrect. Nicotinic stomatitis affects the HARD PALATE in smokers — characterized by white diffuse discoloration with red dot openings of salivary ducts.
• D. Incorrect. Herpetic stomatitis causes multiple vesicles and ulcers, fever, and lymphadenopathy — not a localized reaction under a metal framework.