Close-up

What is this fold of tissue growing under my denture, and does it need surgery?

Fibrous growth at the denture edge, redness in the palate and a flabby ridge are three separate conditions, and their treatments differ too

If you have noticed a folded piece of tissue at the edge of a denture you have worn for years, one that moves when you hold it between your fingers, it has a name: fibrous growth linked to the denture edge, known as epulis fissuratum. Sometimes the part of the palate covered by the denture also turns red alongside this, and that is a separate condition. A third is a soft ridge at the front of the upper jaw that has taken the place of the bone, and that shifts when pressed with a finger. All three arise from the same cause, the foundation under the denture changing over the years, but their treatments differ from one another, and what is done for one does not help another. Telling apart which one just needs the denture adjusted and which one needs surgery is what this page is about.

Short answer

Most likely a fibrous growth caused by the denture edge pressing on the same spot for years, and it does not always need surgery. Early on, while the tissue is still soft and red, shortening the denture's edge or relining it usually makes the complaint go back. If the tissue has hardened into a fibrous, permanent fold, it will not disappear completely even once the pressure is removed; in these cases it needs surgical removal, and sometimes tissue added to the area afterwards. Telling the two apart by eye is not possible. Any sore or swelling that has not gone within two to three weeks needs an examination without exception.

The three most common conditions: Fibrous growth at the edge, redness in the palate, a flabby front ridge
How common it is: One study found at least one lesion in 78% of denture wearers
The strongest factor you can change: Taking your denture out at night and cleaning it every day
The rule that is not up for debate: A sore or swelling that has not gone in two to three weeks needs an examination

What is happening under the denture, and which condition is which

After teeth are taken out, the bone that carried them enters a slow, continuous process of resorption. The denture, though, keeps the shape it had on the day it was made. As the years pass, the denture sits lower, its edge sinks into the fold between the gum and the cheek or lip, and constant pressure builds up along that line. The body responds to this chronic irritation by producing connective tissue. What results is a soft fold that takes in the denture's edge, often in two leaves with a groove left between them. In the literature this is known as epulis fissuratum, or inflammatory fibrous hyperplasia.

There are measurements showing how common this is. In a cross-sectional study published in Medicina Oral Patología Oral y Cirugía Bucal, at least one denture-related lesion is found in 78% of 97 upper denture wearers. The breakdown is: denture stomatitis 63%, fibrous growth 19%, traumatic ulcer 11%, angular cheilitis 8%, and frictional keratosis 2%. In the same study, the habit of leaving the denture in overnight is found to be a factor that triples the risk of a lesion; plaque build-up, never soaking the denture in a cleaning solution, and the denture having been in use for a long time are also significant factors.

The second condition is denture stomatitis, the redness of the part of the palate covered by the denture. A systematic review pooling 28 studies and 4,243 people, published in the Journal of Fungi, states that this condition is reported at a frequency ranging from 20–67% in denture wearers. Underneath it there is usually an overgrowth of yeast; predisposing factors listed include not taking the denture out at night, poor denture and mouth hygiene, the denture ageing and becoming porous, dry mouth, diabetes and heavy smoking. The most misleading thing about this condition is that it is silent: the review states that patients often report no complaint at all and that it is only picked up at examination, though some people have a mild burning feeling or a salty taste.

A study summarising the systematic reviews of the last decade, published in the International Journal of Dentistry, gives the same frequency range and splits the condition into three grades: a mild form limited to pinpoint redness, redness spread across the whole palate, and the most advanced grade, nodular, cauliflower-like growths. This most advanced grade is reported in 4.43% of cases. The same review lists the treatment steps as: first removing predisposing factors, correcting denture hygiene, stopping night-time wear, relining or replacing a denture that no longer fits, and an antifungal applied locally when needed. Surgical or laser removal comes up only in advanced cases that do not resolve.

The third condition is the flabby ridge. In the definition used by the randomised trial published in BMC Oral Health, this is excessively mobile soft tissue that has taken the place of bone, seen most often at the front of the upper jaw, and it is the result of the bone resorption that continues after tooth loss. The problem here is not inflammation or irritation but the foundation being unstable: the denture slides on this tissue with every bite. The same study compares an intraoral scan with the conventional window technique in 26 patients and finds no significant difference between the two methods in either quality of life or retention. Another notable finding is that denture retention drops by close to a quarter within six months in both groups, meaning the foundation underneath keeps changing.

What these three conditions have in common is that the foundation under the denture changes over the years, but their treatments differ. With fibrous growth, the issue is mechanical: the edge causing the pressure. With denture stomatitis, the issue is microbiological and to do with hygiene: plaque build-up and a denture not taken out at night. With the flabby ridge, the issue is to do with the foundation, and it is managed by way of the impression technique. Trying to solve one with the treatment for another is the most common mistake. Making a new denture for someone with a red palate brings the same picture back within a few months if habits have not changed; and using an antifungal for a fibrous fold at the edge has no effect at all.

Let us also state here where the evidence stays weak. We could not find a randomised study showing in which cases fibrous growth resolves with denture adjustment and in which it goes on to surgery; the literature on this topic consists largely of individual case reports, and a single case does not establish a general rule. Reviews of denture stomatitis also state their own limits: results are inconsistent between studies, sampling methods differ, and the quality of the research included spreads across a wide range. So the route map below shows the common line of clinical practice, not an algorithm settled by evidence.

When adjusting the denture is enough, and when surgery is discussed

The distinction below shows the general line followed in clinics. The decision is set by the tissue's consistency, its size and how long it has been there; only the dentist who examines you can say this.

The tooth can be saved

If the tissue is still soft and redFor a fold that is newly formed, blanches when pressed with a finger and looks inflamed, the first step is removing the pressure. The denture's edge is shortened, it is relined, or a soft liner is applied for a while. Improvement in the complaint during this period is the expected outcome.
If redness in the palate is the main findingIf redness comes alone or with mild burning, the real work is hygiene and stopping night-time wear. In the steps the review lists, surgery comes last and is considered only for advanced growths that do not resolve.
If the denture has not been renewed for yearsBecause the bone underneath has resorbed, the denture no longer fits, and this is why the irritation is constant. In a case like this, the denture itself is dealt with before touching the tissue; otherwise, tissue that is removed forms again for the same reason.
If you have a flabby ridgeIn this condition the first route is not surgery but the impression technique. In the randomised trial, no difference in outcome is found between the intraoral scan and the conventional window technique, but patients say they prefer the scan, giving less chair time and less discomfort as their reasons.

Saving it is unlikely to hold

If the tissue has hardened into a permanent foldMature fibrous tissue does not disappear on its own even if it shrinks somewhat once the pressure is removed. One of the standard procedures under what is called pre-denture preparation surgery is exactly this removal of excess tissue caused by irritation. In these cases, adjusting the denture alone is not enough.
If a sore or swelling has not healed in two to three weeksThis is no longer a matter of denture adjustment. NICE's guideline on suspected cancer recommends referral for suspected cancer where unexplained ulceration in the mouth lasts longer than three weeks. Waiting to see is not the right approach.
If there is a red, or mixed red and white, areaThe same guideline recommends urgent assessment by a dentist for a lump on the lip or in the mouth, and for red, or mixed red and white, patches. An area like this should not be dismissed on the assumption that it is denture irritation.
If the tissue is hard, bleeds or is growing fastHardness, spontaneous bleeding, rapid growth and a feeling of the tissue being fixed to what is around it are findings you should not delay having examined. In a case like this, sending the removed piece for pathological examination is standard practice.

The route followed in the clinic

The sequence below shows the steps generally followed for a patient who comes in with a tissue growth under a denture. Some of the steps may be skipped; what decides this is the consistency of the tissue and the state of the denture.

1
Examination and distinguishing the condition
The dentist first distinguishes which condition is being seen: a fibrous fold sitting at the denture edge, widespread redness in the palate, or a mobile ridge. The tissue's consistency, its borders, how long it has been there, and its relationship to the denture's edge decide this. If a finding raises suspicion, the sequence moves straight to tissue examination.
2
Removing the irritation
The edge of the denture that is causing the pressure is shortened, and a soft liner may be applied for a while. Some dentists ask for the denture to be left out for set periods to see the tissue's true shape. This period is both a treatment and a test: how much the tissue improves once the pressure is removed decides what happens next.
3
Relining the denture, or making a new one
If the denture no longer fits because the foundation has changed, this is where the real work is done. Relining can give relief quickly; if bone resorption is advanced, a new denture comes up instead. If this step is skipped, every treatment that follows stays temporary.
4
Surgical removal, if needed
Hardened fibrous tissue is removed surgically, and the piece taken is sent for pathological examination. When a wide area is removed, the fold between the gum and cheek can become shallow; because of this, in some cases a procedure to deepen the fold is done in the same session, with tissue added to the area. Widening the fold and adding soft tissue to the area are the procedures done for this purpose.
5
Healing and a new denture
If surgery was done, you wait until the tissue settles into shape, and a new denture or a new liner is made at the end of this period. If it is done sooner, the denture ends up made to fit a foundation that has not settled yet. If the same habits continue, the condition comes back; stopping night-time wear and daily cleaning are part of the treatment at this point.
6
Whether to continue with a denture, or discuss fixed teeth
If bone resorption is advanced, every renewed denture reaches the same point again after a few years. This distinction is decided by the bone in your jaw, and it cannot be stated without an image. If you have a panoramic X-ray or a CBCT scan, send it through the form; the dentist who will carry out the treatment reads the image, and we will reply within 24 hours on whether continuing with a denture or fixed teeth on implants is on the table for you. This is a preliminary assessment; the final decision is made after an examination and a CBCT scan.

Routes discussed

The options below are less alternatives to one another than options matching different conditions and different grades.

Edge adjustment and a soft liner

The lightest intervention. The edge causing the pressure is shortened, and, if needed, a soft liner is applied for a while to let the tissue settle down. This is the first route chosen for soft, red tissue seen early on.

Relining the denture

If bone resorption has left a gap between the denture and the tissue, this gap is filled. If the cause of the irritation is a denture that no longer fits, this is the work that needs doing before touching the tissue.

A new denture

If the denture is very old, broken, or bone resorption has advanced beyond what relining can address, a new denture comes up. If the new denture needs to be made after surgery, you wait until the tissue has settled into shape.

Surgical removal and adding tissue

This is the real treatment for hardened fibrous tissue. The piece removed is sent for pathological examination. In wide areas, a procedure to deepen the fold can be added so that it does not stay shallow, and soft tissue can be placed in the area.

Fixed teeth on implants

All the conditions under a denture arise from support being taken from the gum. Fixed teeth take their support from the bone instead, and the chronic pressure created by the denture's edge disappears. In our plan, a CBCT scan is taken and the plan is checked on day one, the implants are placed, a digital scan is taken and the first try-in teeth are fitted; on day two, try-ins are done and the final shade is chosen; on day three, the final teeth are fixed in place. The teeth fitted on day three are the final fixed teeth.

Risks, and the most common mistakes

In this condition, the real risk does not come from the procedure itself but from doing things in the wrong order and from delay. The following are points that both the literature and everyday practice point to.

Removing the tissue without removing the cause

If the denture keeps being used in the same way, fibrous tissue forms again along the same line. Surgery does not replace removing the pressure; the two are done together. Removed tissue coming back is usually not a surgical failure but the result of a denture adjustment that was left incomplete.

Assuming a sore in the mouth is a denture sore

Most denture sores come from pressure and close once the pressure is relieved. A sore that does not close means something is continuing. The NICE guideline recommends referral for suspected cancer where unexplained ulceration in the mouth lasts longer than three weeks; do not stretch this threshold on your own.

Dismissing redness in the palate because there is no complaint

The systematic review states that denture stomatitis often causes no complaint at all and is only picked up at examination. Not hurting does not mean it is fine; left untreated, it can progress to the most advanced grade.

Not taking the denture out at night

Night-time wear has been measured as a factor that triples the risk of a lesion, and it is also counted as the main predisposing factor for denture stomatitis. A three-year follow-up study in very elderly people found the risk of pneumonia markedly higher in those who slept with their denture in. Unless there is a reason not to, the denture is taken out at night.

The fold staying shallow after surgery

When a large amount of tissue is removed, the fold between the cheek or lip and the gum can become shallow, reducing the surface the denture can grip. Widening the fold and adding soft tissue to the area are the procedures done to address this problem.

If surgery was done, how the following days go

The sequence below shows the general course after a procedure to remove fibrous tissue from under a denture. It can shift by a few days depending on the size of the area removed and whether tissue was added.

The first three days
There is tenderness and mild swelling in the area. Soft, lukewarm food, not putting strain on the area, and taking the medicines you have been given regularly are the basis of this period. For how to use the medicines and any interactions, check the leaflet and ask your pharmacist or dentist.
Week one and two
The wound edges close, and stitches, if there are any, are removed during this period. Your dentist decides when and how the denture will be worn; in some cases it is worn with a temporary liner, in others it is not worn at all for a while. The pathology result usually comes back during this period.
Week three and four
The tissue starts to settle into shape. The time to take an impression for a new denture or a new liner is set during this period. An impression taken too early records a foundation that has not settled yet, and the denture stops fitting within a short time.
The following months
Because the bone underneath keeps resorbing, the denture loosens again over time. In the randomised trial in patients with a flabby ridge, retention drops by close to a quarter within six months. How often check-ups happen is set by the clinic's follow-up plan.

Message us right away if

A wound that has not closed in two to three weeks. This is no longer something a denture adjustment will resolve. The NICE guideline recommends referral for suspected cancer where unexplained ulceration in the mouth lasts longer than three weeks. Do not put off getting an appointment.
Tissue that is hardening, bleeding or growing fast. Spontaneous bleeding, hardness and rapid growth are findings that need assessing. These are not expected to be explained by denture irritation.
Swelling in the neck that does not go. The same guideline also lists unexplained, persistent swelling in the neck among the reasons for referral. Having it alongside findings inside the mouth makes the situation more urgent still.
A high temperature, spreading swelling or a bad taste. The expected course after surgery is for things to ease off. Increasing swelling, a high temperature and a bad taste in the mouth can be signs of infection; call the clinic the same day.

How this treatment appears in a quote

This is not a single procedure but a process made up of a combination of steps, and which steps will be needed is not clear before the examination. You will not find figures here; these are the things to look at when reading a quote:

Which steps are genuinely needed: Edge adjustment, relining, a new denture and surgery are separate items. Ask, one by one, which of these appear in the quote you have been given, and why each one is needed.
The size of the area removed, and whether tissue will be added: Removing a small fold is not the same job as removing a wide area and deepening the fold. If soft tissue will be added, that is a separate step too.
Whether pathological examination is included: Sending removed tissue for examination is standard practice. Find out from the start whether this examination is included in the price.
Whether the denture will be renewed afterwards: In most cases, a new liner or a new denture is needed after surgery. What sets the total is often not the surgery itself but this last step.

Frequently asked questions

Could this fold at the edge of my denture be cancer?

Most likely not; a benign build-up of tissue caused by the denture edge pressing on the same spot for years is the far more common explanation for this. But telling the two apart by eye is not possible, and that is why there is a threshold: NICE's guideline on suspected cancer recommends referral for suspected cancer where unexplained ulceration in the mouth lasts longer than three weeks. This is also why sending removed tissue for pathological examination is standard practice.

If I do not wear the denture at all for a while, will it clear up on its own?

Partly. If the tissue is still soft and red, it improves noticeably once the pressure is removed. If it has hardened into a fibrous fold, it will not disappear completely even if it shrinks somewhat. Also, not wearing the denture at all is not a long-term solution; the real issue is why the denture is pressing, meaning how much the foundation underneath has changed.

My palate is red but does not hurt at all; does it matter?

Yes, it does. A systematic review pooling 28 studies states that denture stomatitis often causes no complaint at all and is only picked up at examination; some people have a mild burning feeling or a salty taste. Left untreated, it is a condition that can spread across the whole palate and turn nodular at its most advanced grade. Having no complaint does not mean no treatment is needed.

Should I take my denture out at night?

Yes, unless there is a reason not to. A cross-sectional study finds that leaving the denture in overnight is a factor that raises the risk of a denture-related lesion by around three times. Reviews of denture stomatitis also count night-time wear as the main predisposing factor. A three-year follow-up study in very elderly people also found the risk of pneumonia markedly higher in those who slept with their denture in.

Is using an antifungal enough?

On its own, no. In the steps the review lists, the medicine does not come alone; it comes together with removing predisposing factors, correcting denture hygiene, stopping night-time wear and fixing a denture that no longer fits. If these steps are skipped, the condition comes back once the medicine is finished. For how to use the medicine, how long for, and any interactions, check the leaflet and ask your pharmacist or dentist.

Can the same thing come back after surgery?

It can, if the cause has not been removed. Because fibrous tissue forms from the chronic pressure of the denture's edge, if the same denture keeps being used in the same way, developing again along the same line is the expected outcome. This is why surgery is planned together with relining or replacing the denture, not on its own.

There is a mobile ridge at the front of my upper jaw; is this the same thing?

No, this is a separate condition. It is excessively mobile soft tissue that has taken the place of bone, the result of the bone resorption that continues after tooth loss, and it is seen most often at the front of the upper jaw. The problem here is not irritation but the foundation being unstable. The first route is not surgery but taking the impression without compressing this tissue. In the randomised trial of 26 patients, no difference in outcome is found between the intraoral scan and the conventional window technique.

Instead of making a new denture every time, is there a permanent solution?

If bone resorption has advanced, every renewed denture reaches the same point again after a few years, because support keeps being taken from the gum. Fixed teeth take their support from the bone instead, and the chronic pressure created by the denture's edge disappears. Whether this is possible in your jaw is shown by an image: if you have a panoramic X-ray or a CBCT scan, send it through the form, the dentist who will carry out the treatment reads it, and we will reply within 24 hours. This is a preliminary assessment; the final decision is made after an examination and a CBCT scan.

Sources

Send your X-ray and we will tell you which option is realistic for your tooth.

Get an assessment

Next step

Send your X-ray and we will talk through the options.

Share your CBCT or panoramic X-ray. We will write back within 24 hours on which option is realistic for your tooth.

Get an assessment