Aetiology and clinical appearance
This reactive condition results from movement and loss of even contact of the upper denture base on the palatal epithelium and underlying connective tissues. The clinical appearance can vary between a multitude of small papillary projections, to an appearance of cobblestones, to areas of surface hyperplasia with slit-like clefts between the 'blocks' of hyperplastic mucosa. This latter form is more commonly seen under partial dentures. This clinical appearance represents a hyperplastic type of denture stomatitis (Newton's classification Type III) and is infected with Candida. The tissues may be significantly red and inflamed.
Treatment of the candidal infection involves:
• leaving the denture out during sleep
• thorough scrubbing of the fitting surface of the denture
• leaving the denture in Milton's solution (sodium hypochloride) or, in the case of metal-based dentures, in chlorhexidine solution overnight
• brushing the palatal soft tissue with a toothbrush night and morning
• the use of systemic antifungals, such as fluconazole.
The dentures should be lined with tissue conditioner for daytime use.
Total resolution by such means is unusual and removal of the hyperplastic tissue either with diathermy loop or laser may be needed. The resultant raw surface created by surgery is best covered with the denture lined with a zinc oxide-based periodontal pack.
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