Papillary hyperplasia is a medical condition characterized by an overgrowth of cells that form small, finger-like or wart-like projections on a tissue surface. This condition is almost always benign. The term “hyperplasia” indicates an increase in the number of normal cells in a tissue or organ.
What is Papillary Hyperplasia?
Papillary hyperplasia involves the proliferation of epithelial cells, leading to the formation of multiple, small, nodular lesions. These growths can give the affected tissue a “pebbly” or “mulberry-like” appearance. While it can occur in various parts of the body, inflammatory papillary hyperplasia (IPH) is most frequently observed in the oral cavity, particularly on the hard palate. It can also appear on the alveolar ridges. The lesions are often asymptomatic and may vary in color from pink to red, sometimes appearing somewhat translucent.
Common Causes
The development of papillary hyperplasia is often associated with chronic irritation or inflammation, particularly in the oral cavity. Inflammatory papillary hyperplasia of the palate is strongly linked to the use of removable upper dentures, especially those that are ill-fitting or used continuously, including overnight. Poor oral hygiene and the accumulation of plaque under dentures can also contribute by creating an environment conducive to bacterial and fungal growth, such as Candida yeast.
While dentures are a common factor, papillary hyperplasia can also occur in individuals who do not wear them, particularly those with high palatal vaults or chronic mouth breathing habits. Smoking is another identified risk factor, with granular stomatitis linked to heavy smoking. Hormonal changes, such as those occurring postmenopause, may also increase susceptibility to hyperplastic alterations in oral mucosa.
Detection and Diagnosis
Papillary hyperplasia is often asymptomatic; individuals may not notice its presence until a dental or medical examination. When symptoms do occur, they might include redness and swelling of the mouth lining, especially if a fungal infection like candidiasis is also present. A dentist or physician may identify the condition during a routine physical examination, noting the characteristic pebbly or papillary surface of the affected area.
To confirm a diagnosis and differentiate papillary hyperplasia from more serious conditions, a biopsy is typically performed. This involves taking a small tissue sample from the affected area and examining it under a microscope. Imaging techniques are not typically used for diagnosing oral papillary hyperplasia, but they may be employed for papillary lesions in other parts of the body, such as the breast, where mammography might detect abnormalities that require further investigation.
Treatment and Prognosis
Treatment for papillary hyperplasia depends on the severity and location of the lesions, as well as the underlying causes. For mild cases, addressing the contributing factors, such as improving denture fit, practicing better oral hygiene, and regular removal of dentures at night, may lead to resolution. Antifungal treatments may be prescribed if a Candida infection is present.
In more extensive or persistent cases, surgical removal of the hyperplastic tissue is often recommended. This can be performed using various techniques, including traditional scalpel excision, cryosurgery (freezing), electrosurgery, or laser removal. After surgical removal, it is important to address the original cause, such as by constructing a new, well-fitting denture, to prevent recurrence. While papillary hyperplasia is benign, recurrence is possible if predisposing factors persist. Regular follow-up appointments are often advised to monitor the treated area and ensure long-term healing.