A Denture That No Longer Fits
A 71-year-old woman presents with a 12-year-old maxillary complete denture that she says 'moves when I eat' and 'cuts' her upper gum. She has worn it continuously, day and night, since it was made and has not seen a dentist in 8 years. Examination shows a resorbed maxillary ridge, a large mid-palate soft-tissue swelling that is erythematous and fluctuant under the denture base, and angular redness at both commissures. The denture base is overextended at the posterior palatal seal and shows a midline crack. She is on treatment for hypertension and reports a dry mouth. She asks whether the denture can simply be relined and whether the 'lump' needs surgery.
1. Provide a differential diagnosis for the palatal swelling and explain which features favor your leading diagnosis.
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Leading diagnosis: denture-induced inflammatory hyperplasia (epulis fissuratum-type / inflammatory papillary hyperplasia pattern) with a superimposed denture stomatitis, secondary to chronic trauma and continuous wear.
Features favoring it:
- The swelling lies directly beneath the denture base at the palatal vault, in the distribution of chronic suction and pressure.
- Long continuous wear (day and night for 12 years) with an ill-fitting, cracked base.
- Erythematous, fluctuant tissue consistent with chronic inflammation rather than a neoplasm.
- Angular cheilitis and xerostomia support a candidal component.
Other considerations to exclude:
- Candidal infection alone - likely a co-factor rather than the whole explanation.
- Salivary gland swelling or mucocele - less likely given the broad distribution.
- Mesenchymal or salivary neoplasm (e.g., pleomorphic adenoma, minor salivary gland tumor) - would be firmer, more localized, and not resolve with denture hygiene.
- Squamous cell carcinoma - must be excluded if the lesion is indurated, ulcerated, fixed, or does not resolve after removing the cause.
Key principle: remove the cause first and reassess; biopsy any lesion that persists after a few weeks of no denture wear.
2. The patient wants a quick reline. Justify why that is inadequate, and outline the sequence of care including what you would tell her about denture wear habits and the crack.
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Why a quick reline is inadequate: a reline would copy the existing overextended posterior seal and the cracked base, perpetuate the trauma that produced the swelling, and trap tissue under an ill-fitting surface. It would also mask, rather than address, the need to reassess the healed ridge. The tissue must be allowed to resolve before any impression is taken, or the new prosthesis will fit a distorted foundation.
Sequence of care
- Stop wearing the denture (at least at night, and ideally for a period during the day) and provide written hygiene instructions for the denture and mouth; treat the angular cheilitis and probable candidiasis.
- Reassess the palate after 2–4 weeks. If the swelling persists or is indurated or ulcerated, refer for biopsy.
- Once tissues are healthy, take new impressions and construct a new maxillary complete denture with a correct posterior palatal seal and border extension, rather than relining the old base. The cracked base confirms the acrylic is fatigued and should be replaced.
- Address xerostomia: hydration advice, avoidance of drying agents, and consideration of saliva substitutes; review medications with her physician.
Counseling: explain that continuous day-and-night wear is the main driver of her problem; recommend removing the denture at night and storing it moist. Explain that the 'lump' is most likely a reaction to the denture, that it should shrink once the denture is out, and that surgery is reserved for tissue that does not resolve. Set a review appointment and document everything.