Pathology · patient case question
What is the diagnosis for the pebbly palatal appearance?
Patient case: Denture wearer with uncontrolled systemic disease requiring extraction
Patient: Adult denture wearer requiring an extraction
Chief complaint: Requests removal of a broken-down tooth; also reports burning under the upper denture.
Background: Hypertension and diabetes, both treated with medication. Has worn the same maxillary prosthesis for many years and does not remove it at night.
Vital signs / labs: Blood pressure 150/100 mmHg. HbA1c 7.5%
Current findings: On removing the prosthesis, the palatal mucosa in the bearing area shows a pebbly, cobblestone appearance.
Show answer and explanation
Correct answer: D. Inflammatory papillary hyperplasia
- A. Nicotinic stomatitis gives a diffusely white, fissured palate studded with red dots — the inflamed openings of minor salivary gland ducts — and is caused by heat from pipe or cigar smoking.
- B. Median rhomboid glossitis is a depapillated rhomboid patch on the midline dorsal TONGUE.
- C. Epulis fissuratum is a fold of hyperplastic tissue at the denture FLANGE in the vestibule, not a papillary change in the palatal bearing area.
- D. CORRECT. INFLAMMATORY PAPILLARY HYPERPLASIA presents as multiple small, closely packed papillary projections producing a pebbly or cobblestone surface on the hard palate. It is driven by an ill-fitting prosthesis, continuous wear without nightly removal, poor denture hygiene and superimposed candidal infection.