Papillary hyperplasia

The lining of the mouth is usually reddened and swollen, especially if papillary hyperplasia is accompanied by candidiasis.

What is papillary hyperplasia

Inflammatory papillary hyperplasia is a benign lesion of the oral mucosa resulting from epithelial proliferation. The lesion is mainly found in the maxilla, and usually appears in patients with dental prostheses. It has also been found in edentulous patients without a history of dental prostheses.

Although inflammatory papillary hyperplasia has been associated with ill-fitting dentures and poor oral hygiene, the specific cause is unknown. Inflammatory papillary hyperplasia is known to occur in various age groups and nationalities. However, it is most commonly seen in the third, fourth and fifth decades of life in the white population.

Clinically, inflammatory papillary hyperplasia, found mainly on the hard palate, appears as a reddened area with papillary-like projections and varying degrees of inflammation. In addition, most patients are unaware of the presence of the lesion. It is usually asymptomatic.

The depth and extent of the lesion are usually most visible with bright illumination and a blast of air directed at the site. The air blast causes the lesion to have a swaying motion like that of a wheat field in the breeze.

Causes of papillary hyperplasia

The evidence on the premalignancy of papillary hyperplasia is inconclusive. There are differing opinions on this lesion. Tissue irritation in the denture-wearing patient is thought to play a role as a predisposing factor for carcinoma. Clinical suspicion of papillary hyperplasia should be confirmed by histological examination of the biopsied specimen. Inflammatory papillary hyperplasia may mimic more serious conditions, particularly in patients with dentures.

The classification of the lesion is based on the clinical appearance of the surface morphology. Nodular, papillary and mossy morphology has been observed. Often, the lesion presents a combination of the above morphologic types. The most difficult to observe in the early stages is the lesion with mossy or velvety morphology.

The treatment of papillary hyperplasia is controversial. Denture removal, soft tissue curettage and fabrication of a new denture, surgical excision, cryotherapy and electrocautery have been suggested as treatment modalities.

Symptoms of papillary hyperplasia

Some factors that contribute to the development of inflammatory papillary hyperplasia, also known as denture stomatitis are:

• Chronic use of the denture (i.e., 24 hours a day), without rest.
• Poor oral and dental hygiene.
• Poorly fitting dentures.
• Fungal colonization.
• Allergic reactions to the materials that make up the denture.
• Malignant tumors, nutritional deficiencies, endocrine disorders.

The asymptomatic condition has a prevalence of approximately 50% in a random population of rehabilitated patients with complete dentures. It is characterized by erythematous papillary lesions on the hard palate under the denture base and occasionally on the edentulous mandibular alveolar ridge.

It is usually associated with the growth of Candida organisms. Habitual mouth breathers with a high palatal arch may also present with this condition. Practitioners should also be aware that Candida-associated inflammatory papillary hyperplasia is more common in HIV-infected individuals.

Treatment and prevention of papillary hyperplasia

The etiology of this condition is multifactorial in nature, so effective treatment and preventive measures cannot be singular.

Antifungal therapy

• It is prescribed for:
  • Patients with a confirmed clinical diagnosis (mycological examination).
  • Patients describing a burning sensation of the oral mucosa.
  • Patients at risk for systemic fungal infections due to other diseases, drugs, irradiation treatment ( Candida infection may have spread to another site in the oral cavity/pharynx)
• Local therapy with antifungal agents that must be prescribed by a professional.
• Treatment with antifungals should be continued for 4 weeks.

In addition, oral and denture hygiene should be meticulous and meticulous. A break should be given, as long as possible, to the use of the denture.

Effective plaque control

Although antifungal treatment alone can eradicate C. albicans infection and alleviate the symptoms of stomatitis, dentures must be disinfected and proper denture care must be maintained.

Correction of ill-fitting dentures

Denture stomatitis may improve with the above therapies; however, the hyperplastic tissue will not disappear. In advanced conditions, excision of the hyperplastic tissue may be necessary along with fabrication of a new prosthesis.

Correction of the habits of use of the prosthesis

Stomatitis may recur when antifungal treatment is discontinued. Therefore, it is crucial to educate patients regarding oral and denture hygiene/care to maintain optimal oral health in their edentulous states. Patients should also be reminded to remove dentures at night and while sleeping.