Verrucal-Papillary Lesions - Coggle Diagram
Oral squamous papilloma
Etiology: HPV 2, 6, 11, and 57. HPV 6 and 11 are identified most commonly.
Method of transmission: direct contact between the virus and non-intact mucosa. Very low infectivity. Can also be spread by autoinoculation.
Characteristics: cauliflower-like surface texture, Benign lesion, Exophytic, well circumscribed, pedunculated or sessile mass, May have finger or a hair like projections, White to pink in color, most often on soft palate, lip, tongue
Dental implications: should be removed because of the association of some forms of HPV with oral malignancies and because the patient may be able to transmit the causal viral agent to others.
Treatment and prognosis: conservative surgical excision, cryotherapy, or electrodesiccation usually suffices to treat this lesion. The risk of recurrence is low except in those individuals who are immuno suppressed and therefore have a considerably higher risk.
Characteristics: common wart, Areas of heavy keratinization on the lips, hard palate, and gingiva
Etiology: HPV, Oral lesions caused by autoinoculation from fingers to mouth.
Dental implications: anytime the clinician observes a lesion in the mouth, he or she should perform a quick examination of the patient’s fingers for a similar lesion.
Method of transmission: oral lesions are usually caused by auto inoculation
Treatment and prognosis: surgical excision, may disappear without treatment as the immune system fights the virus
Characteristics: genital or venereal warts, labial/lingual frenulum, soft palate, oral pharynx. Oral lesions begin as popular gross which become nodular, pink, exophytic growths with rough papillary surface
Method of transmission: transmitted by direct oral to oral or oral to genital contact between the virus and compromise mucous membranes
Dental implications: diagnosis and treatment will help to prevent transmission of this virus. This infection is more common and immuno suppressed patients, and the clinician should carefully evaluate the patient’s assessment data for other indications that would suggest the need for a medical referral.
Treatment and prognosis: oral lesions are usually remove surgically using scalpel, Laser, cryo-surgery, or a lecture or surgery. Recurrences are common.
Multifocal epithelial hyperplasia
Characteristics: Characteristics: Heck disease, common in younger age groups, pink to white, slight cauliflower like appearance, multiple lesions, soft on palpation, found on lips, tongue, buccal mucosa.
Treatment and prognosis: surgical excision for biopsy to terminal diagnosis generally resolves without
Etiology: HPV 13 and 32
Method of transmission: surface contact with the virus through a break in the mucosal barrier. Frequently due to localized trauma. The disease is found in crowded areas such as daycare and school where it is easily spread from one child to another.
Dental implications: none
Inflammatory or reactive lesions with a papillary configuration
Characteristics: reactive lesion, produces broad area of small papules, more common on maxillary
Etiology: tissue proliferation due to mild, chronic trauma from Ill-fitting denture
Method of transmission: not applicable
Dental implications: should be treated with a soft denture reline material prior to surgical removal of the lesion and fabrication of a new denture. Also educate on the proper use and care of dentures, including the fact that dentures must be removed from the mouth for a period of time every day.
Treatment and prognosis: denture reline, should not excise lesions if denture is not addressed, treat with antifungal if candidiasis is also present. Excellent prognosis as long as the new dentures are fabricated following the removal of the lesion and the patient is educated about the necessity of periodic a valuations to check the fit of the denture and the health of the underlying mucosa.
Pre-malignant/malignant lesions associated with a rough or papillary surface
Characteristics: some consideration Banan, others lean toward pre-malignant. Dome shaped nodule. Smooth shiny surface. Central crater with a Keratin core. Generally occur on Vermilion border of lower lip. Are not found on intraoral mucous membrane. Associative factors include sun exposure/environmental factors, immune concerns, HPV.
Dental implications: prompt medical referral by the dental healthcare provider. Patient should be educated about prevention and self examination of skin cancer.
Treatment and prognosis: surgical excision, excellent prognosis with complete surgical removal. Untreated lesions may regress spontaneously, leaving a scar.
Characteristics: white patches that develop into cauliflower like papillary, exophytic appearance. Maybe fissured or ulcerated. Invade surrounding structures. Generally do not metastasize. Usually located where smokeless tobacco is placed.
Etiology: spit tobacco
Method of transmission: not thought to be contagious
Dental implications: educate patients about the effects of spit tobacco use and counsel them about tobacco cessation.
Treatment and prognosis: surgical removal or cryotherapy as treatment. Most have a good prognosis. Meta-stasis is rare. Most patients are free of cancer five years after surgery.
Oropharyngeal cancer and tonsillar cancer
Characteristics: papillary appearance, red or white in color, may have cervical and mandibular lymph node involvement. Located on the lateral border and base of tongue, posterior wall of pharynx and tonsillar area.Dental implications: tooth pain, ear pain, and difficulty and eating or swallowing may be reported. Careful palpation of the cervical and mandibular lymph nodes is crucial. If surgery is needed, teeth either may be restored or may be extracted before radiation therapy.
Etiology: risk factors are HPV, sexual practices, alcohol, tobacco, Betel quid use
Dental implications: tooth pain, ear pain, and difficulty and eating or swallowing may be reported. Careful palpation of the cervical and mandibular lymph nodes is crucial. If surgery is needed, teeth either may be restored or may be extracted before radiation therapy.
Treatment and prognosis: prognosis of a patient who developed oral cancer that is HPV positive has a better prognosis than those who do not. Treatment is dependent upon extent of lesion.
Raised lesions with a rough or papillary surface PowerPoint
General and oral pathology for the dental hygienist book, chapter 15