Oral Pathology: Soft Tissue Case #32
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Patient: Adult male.
During a recall examination, multiple soft tissue enlargements are noted on the hard palate. The patient has been aware of the lesions for three to four years. The lesions have been persistent and are larger now than when first noted. They are not painful and do not bleed.
The patient reports gastric upset after taking erythromycin. The patient reports hospitalization for surgical repair of a hernia.
The patient seeks dental treatment when he has problems with his dentures. His last dental visit was two years ago. The patient has worn maxillary and mandibular dentures for eight years. His current dentures are four years old. He wears his dentures while he is sleeping. He says his dentures don't fit as well now as they did when he first received them. The patient cleans his dentures twice a week with a denture cleaner and a special denture brush.
The lesions consist of multiple, compressible, nontender, erythematous, soft tissue nodules which are fixed to the surface mucosa and to the underlying structures. The nodules do not bleed or blanch upon palpation. The surface of each nodule is smooth, but the multiple nodules give the entire lesion a rough texture. Panoramic radiograph reveals no abnormalities of the underlying bone. There is no evidence of skin, major salivary gland, or otologic abnormalities. There is no lymphadenopathy.
There are no radiographs available for this case.
There are no lab reports available for this case.
There are no charts available for this case.
A patient seeks treatment for problems with his dentures. During an examination, multiple soft tissue enlargements are noted on the hard palate that the patient has been aware of for 3-4 years. The lesions consist of multiple, compressible, non-tender, erythematous, soft tissue nodules which are fixed to the surface and to the underlying structures. The nodules do not bleed or blanch upon palpation.
Lesions to Exclude from Differential Diagnosis:
These lesions are described as soft tissue enlargements. Although the enlargements may be due to denture trauma, they are classified as tumors rather than reactive lesions because they are asymptomatic, persistent, and progressive for 3-4 years.
Within the category of tumors, malignant tumors may be excluded because the lesions in this case are of 3-4 years duration and are asymptomatic. Soft tissue cysts and most of the benign tumors may be excluded because they do not produce multiple enlargements in the distribution of the maxillary denture. The location, distribution and appearance of the lesions in this case are diagnostic of inflammatory papillary hyperplasia.
Inflammatory papillary hyperplasia
This lesion can often be diagnosed quickly based on the appearance and history of denture use and thus a diagnostic procedure is unnecessary. Treatment consists of explaining to the patient the nature of the lesions and instructing them of the importance of giving oral soft tissues time to rest by keeping the dentures out at night. Also, the patient, in this case, needs the maxillary denture rebased, relined, or remade. The inflammatory papillary hyperplasia should be excised prior to this if the hyperplasia would interfere with making the impression.