Denture sore mouth (DSM) and Papillary hyperplasia (PH)

DESCRIPTION:  Long treated as separate entities, there is evidence that PH and DSM may be different expressions of the same disease. Both are related to the wearing of dentures. The mildest form of denture sore mouth appears as small, localized and asymptomatic red spots on the posterior palatal mucosa. As the condition worsens, large confluent areas turn crimson red (Fig. 1) . This is the classic form of DSM. In later stages, hyperplasia of palatal mucosa occurs and produces the red, pebbly appearances of papillary hyperplasia (Fig. 2). In some cases of PH, the mucosa has a more mossy than mulberry appearance and the hyperplasia is not apparent until a gentle blast of air opens the crevices revealing the papillary nature of the lesion. Whether or not DSM.
ETIOLOGY:  The cause is unknown but there is evidence that Candida albicans is at least contributory. DSM has been called chronic atrophic candidiasis. Organisms are found more often in PH and DSM than in normal controls. Treatment with the antifungal drugs such as nystatin, clotrimazole and fluconazole have been reported to bring about remission in most cases, especially in DSM. Since organisms have been shown to colonize the tissue surface of the denture, sterilization of the denture with fungicide is indicated.
Factors other than Candida albicans seem to be involved, but it is difficult to assess the role of denture trauma and bacterial pathogens. Because the disease is limited to the area covered by the denture, it is often assumed that the patient is allergic to denture base material.. There is little evidence to support his view. Patients with palatal lesions ordinarily do not have lesions under the lower denture as would be expected if the patient were truly allergic. 



TREATMENT: We know of no effective therapy other than fungicides such as nystatin, clotrimazole, ketoconazole or fluconazole in the usual doses for oral candidiasis. Good oral and denture hygiene may help. The denture should fit well and not be worn at night. In cases of excessively redundant papillary hyperplasia, surgical reduction may provide a better denture base.

PROGNOSIS:  The condition is benign. For many years, papillary hyperplasia had the undeserved reputation of being pre-malignant. It is not.

DIFFERENTIAL DIAGNOSIS:  The disease has such a characteristic appearance that diagnosis is seldom a problem.

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