Lesions due to Ill-Fitting Dentures

Question 1

What is epularis fissuratum?

Answer 1

Tumor-like hyperplasia of fibrous CT that develops in association with the flange of an ill-fitting denture

Question 2

what are the clinical features of epularis fissuratum?

Answer 2

fibroepithelial polyp/leaf-like fibroma

Hyperplastic, redundant folds of tissue

Question 3

How does the epularis fissuratum lesion appear?

Answer 3

Flattened pink mass that is attached to the palate by a narrow stalk (pedunculated)

Edge of lesion is usually serrated and resembles a leaf

Question 4

Where does the epularis fissuratum lesion normally appear?

Answer 4

Hard palate underneath the maxillary denture

Question 5

What are the histopathologic features of epularis fissuratum?

Answer 5

Hyperplasia of the fibrous CT

Multiple folds and grooves occur where the denture impinges on the tissue

Overlying epithelium is frequently hyperkeratotic

Irregular hyperplasia of rete ridges

Epithelium shows inflammatory papillary hyperplasia or pseudoepitheliomatous hyperplasia

Question 6

Tx for epularis fissuratum

Answer 6

Surgical removal and microscopic examination

Ill fitting denture should be remade or relined to prevent a lesion recurrence

Question 7

What is an inflammatory papillary hyperplasia (denture papillomatosis)?

Answer 7

Reactive tissue growth that usually develops beneath a denture

Sometimes classified as part of the spectrum of denture stomatitis

Question 8

What conditions are related to inflammatory papillary hyperplasia?

Answer 8

ill fitting denture

poor denture hygiene

wearing a denture 24/7

candida organisms

Question 9

Where does an inflammatory papillary hyperplasia lesion often occur?

Answer 9

Hard palate below a denture base

Early cases involve the palatal vault while advanced cases cover the entire palate

Question 10

What are other uncommon locations inflammatory papillary hyperplasia can develop?

Answer 10

Edentulous mandibular alveolar ridge or on the surface of an epulis fissuratum

Question 11

What population can develop inflammatory papillary hyperplasia without wearing dentures?

Answer 11

Mouth breathers or those with a high palatal vault

Question 12

How does the mucosa of inflammatory papillary hyperplasia appear?

Answer 12

Erythematous and has a pebbly or papillary surface

Question 13

Are inflammatory papillary hyperplasia usually symptomatic?

Answer 13

YES

Question 14

What are the histopathologic features of inflammatory papillary hyperplasia?

Answer 14

Mucosa shows many papillary growths on the surface that are covered by hyperplastic, stratified squamous epithelium

In advnaced cases, the hyperplasia is pseudoepitheliomatous in appearance and should not be mistaken for carcinoma

CT can vary from loose and edematous to densely collagenized

Chronic inflammatory cell infiltrate has lymphocytes and plasma cells and sometimes PMNS

If underlying salivary glands are present, they often show sclerosing sialadenitis

Question 15

Tx for inflammatory papillary hyperplasia

Answer 15

Removal of the denture may allow erythema and edema to subside in early cases

Improvement can occur with topical or systemic antifungal therapy

For advanced and collagenized lesions, excision of the hyperplastic tissue is done prior to making a new denture

Question 16

What are various surgical methods used for inflammatory papillary hyperplasia

Answer 16

Surgical blade excision

Curettage

Electrosurgery

Cryotherapy

Laser Therapy

Question 17

After removal of inflammatory papillary hyperplasia, what modifications can be done to the denture?

Answer 17

Denture can be lined with a temporary tissue conditioner that acts as a palatal dressing and promotes greater comfort