Verrucal- Papillary Lesions, Resources: General & Oral Pathology for…
Verrucal- Papillary Lesions
Oral squamous papilloma
Etiology: HPVs 2, 6, 11, and 57 have been associated with bengin oral squamous paillomas. HPV 6 and 11 are the most common ones.
Method of Transmission: Direct contact between the virus and nonintat musoca. Can also be spread by autoinoculation.
Characteristics: Painless, exophytic, well-circumscribed, pedunculated, or sessile masses. Cauliflower-like surface texture or may consit of many finger or hair-like projections. Color ranges from white to pink and can be found on lips or any mucosal surface.
Dental Implications: Lesions should be removed because of the association of some forms of HPV with oral malignancies and the patient my be able to transmit the viral agent to others.
Treatment and Prognosis: Surgical excision, cryotherapy, or electrodessicarion. The risk of recurrence is low except in individuals who are immunosuppresed.
Etiology: Approximately 30 different types of HPV can infect the anogeniral tract. HPV 6 and 11 are the most common causes of this infection.
Method of Transmission: Direct contact between the virus and compromised mucous membrane.
Characteristics: Nodular, pink, exophytic growths with a rough paillary surface. Cauliflower-like appearance of the lesion suggests an HPV infection.
Dental Implications: Diagnosis and treatment of this condition will help prevent transmission of the virus. Clinician should carefully evaluate the patient's assessment data for other indications that would suggest the need for a medical referral.
Treatment and Prognosis: Surgically removed using scalpel, laser, cryosurgery, or electrosurgery. Recurrences are common.
Multifocal Epthelial Hyperplasia
Etiology: HPVs 13 and 32
Method of Transmission: Surface contact with the virus though a break in the mucosal barrier.
Characteristics: Pink to whitish, somewhat translucent, and surface is slightly cauliflower-like. Soft on palpation and lesions are most commonly affected the lips, tongue, and buccal mucosa. Numerous discrete papular or nodular growth.
Dental Implications: None
Treatment and Prognosis: Treatment is not always necessary because these lesions will resolve spontaneously without treatment. Conservative excision may be performed to establish a diagnosis.
Etology: Reactive tissue proliferation due to mild, persistent trauma caused almost exclusively by the rubbing of an ill-fitting denture on the mucosa during friction.
Method of Transmission: N/A
Characteristics: Lesions most commonly appear on the palatal mucosa as a field of pink to bright red, clustered papules that are firm to palpation. Always related to the presence of dentures or oral applications.
Dental Implications: Patients should be treated with a soft denture reline material prior to surgical removal of the lesion and fabrication of new denture. Clinician should also educate patient on the proper use adn care for their dentures, also including that dentures should be removed for a period of time every day.
Etiology: NOT clear and its nature is controversial. Exposure of the affected area to sunlight is strongly associated with the development. Other possible factors include the presence of chromosomal abnormalities in the skin, occupation exposure to tar or pitch, a compromised immune status, and exposure to several forms of HPV
Method of Transmission: N/A
Characteristics: Dome-shaped nodules with a smooth shiny surface with a central crater. Found on the the edge of the vermilion border of the lower lip. NOT found within the oral cavity
Dental Implications: Should refer patient to a medical doctor by the dental health provider. Patients should be educated about prevention and self-examination.
Treatment and Prognosis: Surgical excision and the prognosis is excellent with the complete surgical removal.
Etiology: Spit tobacco, either sniff or chewing tobacco and also alcohol is a factor.
Method of Transmission: NOT contagious, although a variety of HPV types have been localized within them
Characteristics: White patches, cauliflower-like papillary, exophytic, appearance that spreads over a large are of mucosa.
Dental Implications: Educate patients about the effects of spit tobacco use and counsel them about tobacco cessation.
Treatment and Prognosis: Surgical removal and cryotherapy. Most patients have good prognosis, as metastasis is rare. Most patients are free of cancer for 5 yrs after surgery.
Oropharyngeal Cancer and Tonsillar Cancer
Etiology: Is conflicting. Some studies suggest that individuals engaging in oral sex and French kissing are linked into this type of cancer. Tobacco and alcohol use.
Method of Transmission: Direct contact
Characteristics: Obvious inflammatory tissue with a papillary appearance and there is often a cervical node involvement and mandibular lymph node. Lesion in the throat is a persistent patch, red or white, lump or thickening, or a neck mass should cause alarm.
Dental Implications: Tooth pain, ear pain, and difficulty in eating or swallowing. Careful palpations of cervical and mandibular lymph nodes are crucial. If surgery is needed, teeth should either be restored or extracted before radiation therapy.
Treatment and Prognosis: Referral to an ear, nose, and throat specialist. Follow up treatment for dental work is necessary. Radiation treatment. The prognosis of the patient who develops oral cancer that is HPV positive has a better prognosis than those who do not
Resources: General & Oral Pathology for the Dental Hygienist (pg. 378-389)