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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 12  |  Issue : 2  |  Page : 112-115

Denture-induced fibrous hyperplasia with minor salivary gland changes - A case report


1 PG Student, Department of Oral Pathology and Microbiology, SRM Dental College, SRMIST, Chennai, India
2 CRRI, Department of Oral Pathology and Microbiology, SRM Dental College, SRMIST, Chennai, India
3 Senior Lecturer, Department of Oral Pathology and Microbiology, SRM Dental College, SRMIST, Chennai, India

Date of Submission04-Mar-2021
Date of Decision22-Apr-2021
Date of Acceptance27-May-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Dr. Chandrasekar Muthulakshmi
Department of Oral Pathology and Microbiology, SRMIST, SRM Dental College, Ramapuram, Chennai - 600 089, Tamil Nadu
India
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DOI: 10.4103/srmjrds.srmjrds_22_21

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  Abstract 


Denture-induced fibrous hyperplasia or epulis fissuratum refers to reactive tissue alteration occurring in response to trauma and chronic irritation due to the badly fitted prosthesis. Pathologic changes observed in the oral mucosa may vary depending on the severity of trauma to the mucosa. Trauma to minor salivary glands caused by the impingement of denture flanges can result in chronic sialadenitis. In this article, we discuss a case of denture-induced fibrous hyperplasia with prominent minor salivary gland changes in a Male patient of age 63 years.

Keywords: Denture, epulis fissuratum, fibrous hyperplasia, minor salivary glands


How to cite this article:
Muthulakshmi C, Subramanian S, Ji SS, Rengabasiyam S, Sundaram SM, Divya B. Denture-induced fibrous hyperplasia with minor salivary gland changes - A case report. SRM J Res Dent Sci 2021;12:112-5

How to cite this URL:
Muthulakshmi C, Subramanian S, Ji SS, Rengabasiyam S, Sundaram SM, Divya B. Denture-induced fibrous hyperplasia with minor salivary gland changes - A case report. SRM J Res Dent Sci [serial online] 2021 [cited 2021 Jul 31];12:112-5. Available from: https://www.srmjrds.in/text.asp?2021/12/2/112/319874




  Introduction Top


Denture-related mucosal lesions occur as a result of acute and chronic irritation to the oral mucosa due to several factors that are associated with dentures.[1] Denture-induced fibrous hyperplasia is one such reactive lesion occurring as a result of chronic trauma caused by the denture.

Epulis fissuratum, inflammatory fibrous hyperplasia, reactive fibrous hyperplasia, denture epulis, or denture-induced tumor are the other terms attributed to reactive tissue response to persistent mechanical irritation by an ill-fitted prosthesis. It usually presents clinically as a single or multiple folds of hyperplastic tissue along the flanges of the denture. The anterior portion of the jaws is more commonly affected than the posterior areas. Histologically, it appears as a dense connective tissue with overlying epithelium frequently exhibiting hyperparakeratosis and hyperplastic rete ridges. Chronic sialadenitis is frequently observed in the minor salivary glands. In this article, a case report of denture-induced fibrous hyperplasia of 63-year-old male patient is discussed, highlighting the histopathological features with prominent changes in the minor salivary glands.


  Case Report Top


A male patient of 63 years age came with a complaint of tissue growth in the upper anterior region for the past 3½ years. The growth was initially small, later gradually increased and attained the present size. The patient was edentulous for the past 15 years and a denture wearer for the past 10 years. There was no history of pain, or any other associated symptoms. Past medical history revealed that the patient was hypertensive and diabetic for the past 15 years, and he was under medication for the same. On intraoral examination, a small pedunculated growth evident on the upper anterior labial sulcus region, which was polypoid or irregular in shape measuring approximately 3 cm × 2 cm in dimension, soft inconsistency, and tender on palpation [Figure 1]. There were no signs of bleeding or secondary changes in surrounding tissues. On clinical examination, provisional diagnosis was given as epulis fissuratum. Surgical excision was done and the tissue was given for histopathological examination. On gross examination, the soft-tissue specimen measured 1.7 cm × 0.5 cm in size, roughly oval in shape, whitish in color, and firm in consistency with smooth surface [Figure 2]. On microscopic examination, the given histopathological section shows a circumscribed mass of connective tissue in association with the parakeratinized stratified squamous epithelium [Figure 3]. The surface epithelium exhibits hyperplasia with arcading pattern of proliferation in few areas and in some areas, there is evidence of pseudoepitheliomatous hyperplasia [Figure 4].
Figure 1: Intraoral photograph

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Figure 2: Gross specimen

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Figure 3: Tissue section showing parakeratinized stratified squamous epithelium in association with underlying fibrovascular connective tissue

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Figure 4: Tissue section exhibiting pseudoepitheliomatous hyperplasia

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The underlying fibrovascular connective tissue contains salivary gland acini [Figure 5] associated with dilated ducts (ductal ectasia) exhibiting hyperplasia [Figure 6], surrounded by chronic inflammatory infiltrate (sialodochitis). The ductal epithelium exhibits mucous metaplasia [Figure 6] in some areas and squamous metaplasia in some areas [Figure 7]. Correlating the clinical and histopathological picture, the final diagnosis was given as denture-induced fibrous hyperplasia.
Figure 5: Tissue section exhibiting salivary gland acini

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Figure 6: Dilated, inflamed duct exhibiting mucous metaplasia (black arrow) and hyperplasia of the ductal epithelium (white arrow)

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Figure 7: Squamous metaplasia of the ductal epithelium

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  Discussion Top


Denture-related mucosal reaction could result from mechanical irritation or accumulation of microbial plaque on dentures or allergic reaction to denture base material. Long-term use of inadequately adjusted, over-extended prosthesis causes hyperplasia in the oral mucosa. Epulis fissuratum refers to the benign, fibrous connective tissue hyperplasia developing in association with the flanges of an ill-fitting denture. Virchoff, coined the term “epulis” which originated from the Greek word Epi meaning upon, ulon meaning gingiva. The use of this term is not appropriate since the affected mucosa is usually the vestibular or palatal mucosa and not the gingiva. Denture-induced fibrous hyperplasia is a much preferred term. Continuous residual alveolar ridge resorption leads to overextension of the denture causing excessive mechanical pressure on the mucosa.[2] Other contributing factors include compromised oral hygiene, the continuous wearing of dentures, age-related changes, smoking, trauma, and irritation to the palatal salivary glands and inappropriate relief chambers.

Denture-induced fibrous hyperplasia occurs commonly in the 30–60 year-old group.[3] Female predeliction is observed due to the denture-wearing habits of women. Women wear dentures more continuously for esthetic reasons when compared to men. Macedo Firoozmand et al. observed that 78% of females who were denture wearers had denture-induced fibrous hyperplasia of the maxilla.[4] The anterior portion of the maxilla is commonly involved since the denture covering area is greater in the maxilla than the mandible.[5] It occurs in 5%–10% of people who wear complete dentures.[3] In accordance with this, the present case is a report of denture-induced fibrous hyperplasia of the anterior maxilla in a 63-year-old female patient.

Clinically, it presents as folds of tissue with normal or erythematous overlying mucosa. The lesion causes discomfort only when it has reached considerable size. When the lesion ulcerates due to continuous irritation and trauma, it may be associated with pain and it may affect the esthetics, mastication, phonetics, and overall health status of the patient. There is a high propensity for the patients with denture injuries to develop oral carcinoma if trauma to the oral mucosa is left unattended for a longer duration. Therefore, the sequelae of ill-fitting dentures should not be overlooked.[5]

Histopathologic features include hyperplastic fibrovascular connective tissue covered by stratified squamous epithelium. As an initial defense reaction, the overlying epithelium exhibits acanthosis, hyperparakeratosis, thickening, and widening of rete pegs. At some instances, there can be the elongation of the rete-pegs giving the appearance of pseudoepitheliomatous hyperplasia. Areas of ulceration could be seen, especially at the folds between the base of the groove. Inflammatory infiltrate consisting of lymphocytes, eosinophils can be seen in the connective tissue. Cutright in 1974 observed that continuous irritation of the minor salivary glands is manifested histopathologically as sialadenitis, sialodochitis, mucous metaplasia, squamous metaplasia of the ductal epithelium, ductal ectasia, and hyperplasia.[6] In the present case, ductal ectasia, sialodochitis, mucous metaplasia, squamous metaplasia, and ductal hyperplasia were observed. Rarely, osseous and chondromatous metaplasia can occur which could be confused for sarcoma. Hence, thorough histological examination is essential to arrive at appropriate diagnosis and to manage the lesion accordingly.

Treatment of denture-induced hyperplasia can be either conservative or surgical based on the size of the lesion. Conservative approach involves removal of the denture flange which can be followed by relining and rebasing after the satisfactory healing of the lesion. Surgical approach includes using either scalpel method, electrocauterization, soft tissue lasers, or liquid nitrogen cryosurgery.[5]


  Conclusion Top


Denture-induced fibrous hyperplasia is a benign, tumor-like hyperplastic overgrowth associated with poorly fitted prosthesis. Pathologic changes of the oral mucosa vary based on the irritation and trauma to the mucosa. Thorough histopathological examination is necessary to treat the lesions appropriately. To prevent the occurrence of such lesions oral care guidelines should include step-by-step instructions to maintain the denture cleanliness. The time of wearing the denture and frequent dental visits should be ensured to maintain the strength of the oral tissues under the denture overtimes.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Parveen R, Patil VA, Surve P. A case report on epulis fissuratum. J Oral Health Community Dent 2019;13:59-61.  Back to cited text no. 1
    
2.
Zarb GA, Bolender CL, Hickey JC, Carlsson GE. Boucher's Prosthodontic Treatment for Edentulous Patients. 10th ed. St. Louis, Missouri, USA: B. I. Publications Pvt Ltd, C. V. Mosby Company; 1994.  Back to cited text no. 2
    
3.
Canger EM, Celenk P, Kayipmaz S. Denture-related hyperplasia: A clinical study of a Turkish population group. Braz Dent J 2009;20:243-8.  Back to cited text no. 3
    
4.
Macedo Firoozmand L, Dias Almeida J, Guimarães Cabral LA. Study of denture-induced fibrous hyperplasia cases diagnosed from 1979 to 2001. Quintessence Int 2005;36:825-9.  Back to cited text no. 4
    
5.
Jainkittivong A, Aneksuk V, Langlais RP. Oral mucosal lesions in denture wearers. Gerodontology 2010;27:26-32.  Back to cited text no. 5
    
6.
Cutright DE. The histopathologic findings in 583 cases of epulis fissuratum. Oral Surg Oral Med Oral Pathol 1974;37:401-11.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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