Pathology · patient case question
What is the diagnosis?
Patient case: Palatal changes beneath a maxillary denture in a tobacco user
Patient: Male, 63 years old
Chief Complaint: Routine review of a maxillary complete denture worn for eight years.
Background: Long-standing pipe and cigarette smoker. Wears the denture day and night.
Current Findings: The hard palate is erythematous with a keratotic, leukoplakic background. Numerous small elevated red papules with punctate central openings — inflamed minor salivary gland duct orifices — are visible across the palatal mucosa.
Show answer and explanation
Correct answer: D. Nicotinic stomatitis (smoker's palate)
- A. Erythroplakia is a velvety RED patch with no keratotic component. It carries the highest malignant transformation risk of any oral lesion and is not the picture here.
- B. Papillary hyperplasia produces a pebbled, cobblestone surface of multiple small nodules on the palatal vault — a fibroepithelial reaction to a poorly fitting denture, not a keratosis with inflamed duct openings.
- C. Denture stomatitis is a well-demarcated ERYTHEMA confined exactly to the denture-bearing area, without keratosis and without the inflamed duct orifices. It is a candidal infection driven by continuous denture wear.
- D. CORRECT. Nicotinic stomatitis is a HEAT-induced hyperkeratosis of the hard palate. The diffuse greyish-white keratotic background is punctuated by red, umbilicated papules representing inflamed and dilated minor salivary gland duct openings. Pipe smoking is the classic cause because of the temperature of the smoke.