Q&A: What is denture induced fibrous hyperplasia?
Author: Sanketh DS, MDS
INTRODUCTION & PATHOGENESIS
Denture induced fibrous hyperplasia, is a reactive lesion caused due to chronic trauma induced by ill-fitting dentures. This lesion is also called by different names such as epulis fissuratum, denture epulis and denture injury tumor. It has to be remembered that, this lesion is not a true tumor and is only a tumor-like reactive lesion.
After long term use of a denture, there is resorption of the alveolar ridges of the maxilla and mandible. As the ridges resorb, the flanges of the denture further extend into the vestibule impinging on the mucosa. Alternatively, ill-fitting dentures with over-extended flanges may impinge on the mucosa. Hence, the mucosa in contact with the denture flange is constantly traumatized and inflamed. This inflammation could cause a reparative response in the underlying connective tissue of the mucosa inducing fibroblasts to proliferate and produce excess collagen. Thus the name, denture induced fibrous hyperplasia.
The lesion usually manifests as rolls or folds of tissue in the facial or buccal vestibular area either anteriorly or posteriorly where the denture flange fits in. More commonly the lesion may manifest as two folds of tissue between which the flange may fit in. Denture induced fibrous hyperplasia has a female predilection and most often manifests in the maxillary or mandibular anterior vestibules. They usually appear to have the same colour of the adjacent mucosa but occasionally, may appear erythematous. The base of the lesion where the flange impinges may be rarely be ulcerated. Lesions are more commonly firm but may also be soft on palpation.
Under the microscope, the bulk of the lesion shows a very fibrous connective tissue that is hypo-cellular. There may be few spindle shaped fibroblasts interspersed in between the fibrous connective tissue. The overlying epithelium is most often hyperplastic with elongated rete ridges.
The lesion is harmless and should be surgically excised. The denture has to be remade, in order to prevent the lesion from recurring.
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Neville BW, Damm DD, Allen CM, Chi A. Oral and Maxillofacial Pathology. South Asian ed. Elsevier; 2016.
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