Denture-related oral lesions comprise a heterogeneous group of mucosal conditions associated with removable complete or partial dentures.
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Common conditions include denture stomatitis, traumatic ulcers, angular cheilitis, inflammatory fibrous hyperplasia, inflammatory papillary hyperplasia, and flabby ridge. Their recognition is important because treatment frequently requires correction of the prosthetic factor rather than management of the mucosal lesion alone.
✅ Common Denture-Related Oral Lesions
| Lesion | Typical Clinical Features | Common Contributing Factors |
|---|---|---|
| Denture stomatitis | Diffuse erythema beneath the denture, usually involving the palatal mucosa. | Candida biofilm, continuous denture wear, poor hygiene, and poorly fitting dentures. |
| Traumatic ulcer | Localized painful ulcer at an area of pressure or mechanical irritation. | Overextended flange, sharp denture border, instability, or fractured or repaired denture. |
| Angular cheilitis | Erythema, fissuring, and soreness at the oral commissures. | Reduced vertical dimension, saliva accumulation, and Candida or bacterial involvement. |
| Inflammatory fibrous hyperplasia | Folded or fibrous tissue along the denture border. | Chronic mechanical irritation from an ill-fitting or overextended flange. |
| Inflammatory papillary hyperplasia | Multiple papillary or nodular projections, commonly on the hard palate. | Chronic denture wearing, poor hygiene, and prolonged mucosal irritation. |
| Flabby ridge | Mobile, fibrous soft tissue over the residual alveolar ridge. | Long-term ridge resorption and unfavorable prosthetic loading. |
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Denture stomatitis is characterized by erythematous inflammation of mucosa covered by a removable denture, particularly the maxillary palatal mucosa. It is strongly associated with Candida biofilm, although its etiology is multifactorial.
Continuous denture wearing, inadequate denture hygiene, denture age, salivary factors, and systemic conditions may contribute to its development. A 2024 systematic review reported a prevalence range of approximately 20–67% across the populations studied.
Clinical management should address both the mucosal condition and the prosthesis:
▪️ Improve denture and oral hygiene.
▪️ Avoid continuous denture wear, particularly overnight.
▪️ Evaluate denture fit, stability, and occlusion.
▪️ Clean and disinfect the denture appropriately.
▪️ Consider topical or systemic antifungal therapy when clinically indicated.
▪️ Evaluate persistent or recurrent lesions for contributing systemic or prosthetic factors.
Importantly, treating Candida without controlling the denture-associated biofilm or prosthetic factors may contribute to recurrence.
2. Traumatic Ulcers
Traumatic ulcers generally occur at sites subjected to excessive pressure or friction. They may develop after insertion of a new denture, following denture adjustment, or when an old prosthesis becomes unstable.
Common causes include:
▪️ Overextended denture borders
▪️ Sharp or irregular acrylic surfaces
▪️ Inadequate denture adaptation
▪️ Excessive occlusal pressure
▪️ Fractured or repaired dentures
▪️ Changes in the supporting mucosa
The prosthesis should be carefully examined and the traumatic factor eliminated. Persistent ulceration requires reassessment rather than repeated empirical adjustment. A lesion that does not resolve after removal of the suspected traumatic factor should be investigated to exclude other pathology.
Recent prospective research confirms that denture-induced lesions can produce substantial pain, particularly during the early period after prosthesis delivery or adjustment.
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Angular cheilitis presents as erythema, fissuring, maceration, or soreness at one or both oral commissures. In denture wearers, it may be associated with reduced lower facial height, saliva accumulation, and microbial colonization.
Management should address the underlying prosthetic and local factors. When fungal or bacterial involvement is suspected, appropriate antimicrobial treatment may be required.
A denture assessment is particularly important when angular cheilitis is recurrent because correction of the vertical dimension and prosthetic relationship may be necessary rather than relying exclusively on topical medication.
4. Inflammatory Fibrous Hyperplasia
Inflammatory fibrous hyperplasia, sometimes referred to as epulis fissuratum when associated with a denture flange, consists of redundant fibrous tissue that develops in response to chronic mechanical irritation.
The principal treatment objective is elimination of the source of trauma. Depending on the size and chronicity of the lesion, management may include:
1. Correction or replacement of the denture.
2. Removal of the traumatic flange.
3. Surgical excision when significant fibrous tissue persists.
4. Histopathologic examination when clinically indicated.
Denture-induced fibrous hyperplasia has been reported among the most frequent denture-related lesions in clinical populations.
5. Inflammatory Papillary Hyperplasia
Inflammatory papillary hyperplasia usually appears as multiple small papillary or nodular elevations of the palatal mucosa beneath a maxillary denture.
It is associated with chronic denture use and local inflammatory factors, particularly inadequate hygiene and prolonged wearing. The clinical approach should include:
▪️ Removal of contributing prosthetic factors.
▪️ Improvement of denture hygiene.
▪️ Appropriate denture rest periods.
▪️ Assessment of denture fit.
▪️ Management of Candida when clinically indicated.
Advanced or persistent tissue changes may require surgical management before fabrication of a new prosthesis.
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The examination should evaluate both the oral tissues and the denture. A useful clinical sequence is:
History → mucosal examination → denture examination → identification of causative factor → correction → reassessment
Particular attention should be given to:
▪️ Duration of denture use
▪️ Night-time denture wearing
▪️ Denture hygiene
▪️ Denture stability and retention
▪️ Border extension
▪️ Occlusal relationships
▪️ Areas of pressure or ulceration
▪️ Presence of erythema or pseudomembranous changes
▪️ Recurrent lesions
▪️ Systemic or medication-related factors
Longer denture use, biofilm accumulation and night-time wearing have been associated with increased occurrence of denture-related lesions in observational research.
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Prevention focuses on maintaining healthy mucosa while preserving appropriate prosthetic function.
Key preventive measures include:
▪️ Daily mechanical cleaning of dentures.
▪️ Regular professional evaluation of the prosthesis.
▪️ Avoidance of continuous denture wear.
▪️ Periodic assessment of denture fit and stability.
▪️ Early correction of pressure areas.
▪️ Regular examination of the oral mucosa.
▪️ Replacement or substantial rehabilitation of dentures when deterioration compromises function or causes chronic tissue irritation.
The American Dental Association notes chronic inflammation, oral ulceration and treatment-resistant Candida-related denture stomatitis among clinical circumstances that may indicate the need for professional evaluation for denture replacement.
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Denture-related oral lesions are multifactorial conditions in which the prosthesis, oral microbiota, mucosal tissues and patient-related factors interact. Denture stomatitis receives particular attention because of its frequent association with Candida biofilm, but traumatic and inflammatory lesions are also clinically important.
Current evidence supports an approach that does not focus exclusively on pharmacological treatment. Denture hygiene, prosthetic evaluation, elimination of mechanical irritation and appropriate denture-wearing practices are fundamental components of management. Systemic factors, including diabetes and conditions associated with impaired immunity or altered salivary function, may further modify susceptibility.
The clinical challenge is therefore to identify whether the lesion is primarily infectious, traumatic, inflammatory, prosthetic, or multifactorial, while recognizing that more than one mechanism may coexist.
🎯 Clinical Recommendations
1. Examine the denture and the mucosa together rather than treating the lesion in isolation.
2. For traumatic lesions, eliminate the mechanical cause before considering additional treatment.
3. In denture stomatitis, address Candida-associated biofilm and denture hygiene together with the mucosal infection.
4. Avoid continuous denture wearing and incorporate appropriate overnight denture removal.
5. Reassess persistent lesions after correction of the suspected prosthetic cause.
6. Biopsy or refer persistent, indurated, atypical, or non-healing lesions when the clinical course is inconsistent with simple denture trauma.
✍️ Conclusion
Denture-related oral lesions are common clinical findings that range from reversible mucosal inflammation to chronic hyperplastic changes. Denture stomatitis, traumatic ulcers, angular cheilitis, inflammatory fibrous hyperplasia, and inflammatory papillary hyperplasia represent important conditions to recognize during routine prosthodontic examinations.
Effective management depends on identifying and correcting the underlying prosthetic, mechanical, microbial, and patient-related factors. Regular follow-up remains essential because changes in residual ridges, denture fit, hygiene, and mucosal health can progressively increase the risk of recurrent lesions.
📚 References
✔ American Dental Association. (n.d.). Denture care and maintenance. ADA.
✔ Carvalho-Silva, J. M., Gaspar, C. S., Dos Reis, A. C., & Teixeira, A. B. V. (2025). Denture stomatitis: Treatment with antimicrobial drugs or antifungal gels? A systematic review of clinical trials. The Journal of Prosthetic Dentistry, 134(4), 1108–1114. https://doi.org/10.1016/j.prosdent.2023.12.014
✔ Costa, R. M. B., Poluha, R. L., Canales, G. D. L. T., Santiago Junior, J. F., Conti, P. C. R., Neppelenbroek, K. H., & Porto, V. C. (2020). The effectiveness of microwave disinfection in treating Candida-associated denture stomatitis: A systematic review and meta-analysis. Clinical Oral Investigations, 24, 3821–3832. https://doi.org/10.1007/s00784-020-03599-5
✔ Mandali, G., Sener, I. D., Turker, S. B., & Ulgen, H. (2011). Factors affecting the distribution and prevalence of oral mucosal lesions in complete denture wearers. Gerodontology, 28(2), 97–103. https://doi.org/10.1111/j.1741-2358.2009.00351.x
✔ Perić, M., Miličić, B., Kuzmanović Pfićer, J., Živković, R., & Arsić Arsenijević, V. (2024). A systematic review of denture stomatitis: Predisposing factors, clinical features, etiology, and global Candida spp. distribution. Journal of Fungi, 10(5), 328. https://doi.org/10.3390/jof10050328
✔ Zomorodian, K., Haghighi, N. N., Gholamzadeh, M., et al. (2016). Denture stomatitis and Candida albicans in Iranian population: A systematic review and meta-analysis. Iranian Journal of Public Health, 45(3), 283–292.
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Souce: Mubarak S, Hmud A, Chandrasekharan S, Ali AA. Prevalence of denture-related oral lesions among patients attending College of Dentistry, University of Dammam: A clinico-pathological study. J Int Soc Prevent Communit Dent 2015;5:506-12.