Inflammatory papillary hyperplasia
Inflammatory papillary hyperplasia (IPH) is a benign lesion of the oral mucosa which is characterized by the growth of one or more nodular lesions, measuring about 2mm or less. The lesion almost exclusively involves the hard palate, and in rare instances, it also has been seen on the mandible. The lesion is mostly asymptomatic and color of the mucosa may vary from pink to red. In general, IPH is associated with the use of removable upper dentures, although it also has been found in dentulous patients with no history of a dental prosthesis. The majority of lesions are found beneath ill-fitting dentures of long use and in patients who do not take their dentures out overnight. The lesion seems to result from a combination of chronic, mild trauma which permit frictional irritation. A poor fitting denture never acquires papillomatosis. However, there must be some unidentified predisposing factors present in those patients who develop the lesion. It is also induced by low-grade infection by bacteria or Candida yeast. It is occasionally seen in patients without dentures but with high palatal vaults or those with habit of breathing through the mouth. Signs and symptoms Papillary hyperplasia is seen in middle-aged and older persons, and there is a strong female predilection (2:1). The disease occurs on the bone-bound oral mucosa of the hard palate and alveolar ridges. Inflammatory papillary hyperplasia is usually asymptomatic. It presents as a cluster of individual papules or nodules that may be erythematous, somewhat translucent, or normal in surface coloration. Mucosa is erythematous and has a pebbly or papillary surface. Many cases are associated with denture stomatitis. Often the entire vault of the hard palate is involved, with the alveolar mucosa being largely spared. White cottage cheese–like colonies of Candida may be seen in clefts between papules. There is seldom pain, but a burning sensation may be produced by the yeast infection. Early papules are more edematous, whereas older ones are more fibrotic and firm, being individually indistinguishable from irritation fibroma. Candida -associated palatal papillary hyperplasia also has been reported in dentate patients with human immunodeficiency virus (HIV) infection. Cause The origin of the lesion is unclear. This condition appears to be of an inflammatory nature. An excessive denture palatal relief area, creating a void between the denture base and the tissue of the palate, encourages food entrapment and so encouraging bacterial and fungal growth between the two surfaces. This was demonstrated in 80 per cent of the patients. The other causes may include ill-fitting or poorly contoured dentures, irritation of the palatal salivary glands poor oral hygiene and continuous day and night denture use. ll-fitting or poorly contoured dentures can result in excessive frictional movement of the denture bases on the oral mucosa, creating the chances of developing inflammatory papillary hyperplasia. Inflammatory papillary hyperplasia is commonly associated with Candida infection. Strong correlation between denture stomatitis and poor hygiene in the use of prostheses have been found in a few studies in Brazil. Denture stomatitis is the most frequent