Epulis fissuratum is hyperplastic tissue caused by:

Correct answer: D. An ill-fitting or overextended denture flange chronically traumatizing the vestibular mucosa

• A. Candidal infection under the denture causes erythematous stomatitis (Type II denture stomatitis) — not fibrous tissue folds.
• B. Inflammatory papillary hyperplasia causes cobblestone-like nodules under the denture base on the hard palate — not the vestibular folds of epulis fissuratum.
• C. Phenytoin, cyclosporine, and calcium channel blockers cause diffuse gingival enlargement — not the fold-of-tissue pattern at the vestibule typical of epulis fissuratum.
• D. Correct. Epulis fissuratum (also called denture-induced fibrous hyperplasia) is reactive connective tissue overgrowth caused by chronic irritation from an ill-fitting or overextended denture flange. It appears as folds of tissue in the vestibule, often with a fissure created by the denture border.