Micro & Immunology · patient case question
What is the principal etiologic organism involved in this 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: C. A fungus
- A. Bacterial plaque accumulates on the fitting surface and contributes to the inflammatory load, but it is not the principal organism. Antibacterial therapy alone does not resolve the lesion.
- B. Protozoa have no role in denture-associated palatal disease.
- C. CORRECT. CANDIDA ALBICANS. Continuous denture wear creates a warm, moist, low-oxygen environment beneath an acrylic surface that Candida colonises readily, particularly when the denture is never removed and hygiene is poor. The resulting chronic atrophic candidiasis (denture stomatitis) is the substrate on which papillary hyperplasia develops.
- D. Viruses do not produce this pattern. Viral lesions of the palate are vesicular or ulcerative and acute, not chronic and papillary.
Note: Management is a package, not a single drug: remove the denture at night, clean it and soak it in an antifungal or a disinfectant (the prosthesis is the reservoir — treating the mouth alone guarantees reinfection), treat the mucosa with a topical antifungal such as nystatin, and correct the ill-fitting prosthesis.
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