Pathology · patient case question
What is the most likely diagnosis of the PALATAL lesion?
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: A. Inflammatory papillary hyperplasia
- A. CORRECT. INFLAMMATORY PAPILLARY HYPERPLASIA is the pebbly, granular, erythematous overgrowth of the hard palate that develops beneath an ill-fitting denture worn continuously by a patient with poor hygiene. The surface is made of multiple small papillary projections, giving the characteristic cobblestone appearance. It is a reactive hyperplasia and is not premalignant.
- B. Squamous cell carcinoma of the palate is typically an indurated ulcer or a fixed exophytic mass in a smoker or drinker, not a symmetric pebbly erythema confined to the denture-bearing area.
- C. Nicotinic stomatitis produces a diffusely white, keratotic palate studded with red inflamed minor salivary duct openings, and is caused by heat from pipe or cigar smoking, not by a denture.
- D. Epulis fissuratum is the folded, fibrous hyperplastic tissue that forms along an overextended denture FLANGE in the vestibule — which is exactly the SECOND lesion described in this patient, at the depth of the groove. It does not occur on the hard palate.
Note: This case contains TWO separate denture-induced lesions — papillary hyperplasia on the palate and epulis fissuratum in the vestibule. The recall noted the exam did not specify which lesion the questions referred to, so read the stem carefully and match the answer to the anatomical site being named.