A 'pebbly' lesion under a denture — what could it be?

Correct answer: A. Inflammatory (papillary) gingival hyperplasia

• A. Correct. Chronic ill-fitting denture irritation classically produces inflammatory papillary hyperplasia, presenting as a 'pebbly'/cobblestone-appearing erythematous lesion on the palate or alveolar ridge.
• B. While any persistent lesion should be biopsied if it does not resolve, the classic 'pebbly' appearance under a long-worn denture is most consistent with papillary hyperplasia rather than carcinoma.
• C. This presentation is pathological, not a normal mucosal finding.
• D. A fibroma typically presents as a smooth, discrete nodule rather than a diffuse pebbly/papillary surface.

Note: Before making a new prosthesis for a patient with a 'pebbly' red lesion, resolve the pathological issue first.