Oral Surgery · patient case question
The prosthesis has been adjusted and antifungal therapy completed, but the palatal lesion persists unchanged. What should you do next?
Patient case: Edentulous patient with reddened palatal mucosa
Patient: Male, edentulous, wearing complete maxillary and mandibular dentures
Chief complaint: "My upper plate has been feeling loose and my mouth is sore."
History: Wears both dentures continuously — day and night — and reports he has never removed them for cleaning. Denture hygiene is poor. The prostheses are several years old and no longer fit well.
Findings: Two lesions are present. The hard palate beneath the denture is diffusely reddened with a pebbly, granular surface. A second reddened, folded lesion sits at the depth of the labial vestibule along the denture flange.
Show answer and explanation
Correct answer: C. Excise the lesion and submit it for histopathologic examination
- A. Delivering a new prosthesis without addressing the persistent lesion repeats the original error, and postponing evaluation for six months leaves an undiagnosed lesion in place.
- B. Additional antifungal therapy is futile against established fibrous hyperplasia. The papillary tissue itself no longer resolves with medical management once it has organised.
- C. CORRECT. Once the CAUSE has been removed and the lesion still does not resolve, the tissue has become fibrotic and irreversible — and any lesion that persists after the etiology is eliminated must be BIOPSIED. Surgical removal (excision, laser or electrosurgery) both establishes the diagnosis histologically and creates the sound, level tissue bed a new denture needs.
- D. Impressing over a hyperplastic, inflamed and mobile tissue bed records a distorted, unstable form. The new denture would fit tissue that is about to change, and the fit would be lost.
Note: The governing principle is general: ANY oral lesion that fails to resolve within roughly two weeks of removing its suspected cause requires biopsy. Tissue conditioning with a soft liner for one to two weeks before surgery is a useful intermediate step, since it lets reversible inflammation settle so the surgeon removes only what is genuinely irreversible.