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Verrucal or Papillary Lesions - Coggle Diagram
Verrucal or Papillary Lesions
Infections
Oral Squamous Papilloma
Etiology
= HPVs 2, 6, 11, and 57 have been associated with benign oral squamous papillomas. HPV’s 6 and 11 are identified most commonly.
Method of Transmission
= transmitted by direct contact between the virus and non-intact mucosa; very low infectivity; can also be spread by auto inoculation.
EO Characteristics
= Not applicable
PO and IO Characteristics
= Painless, exophytic, well circumscribed, pedunculated, or sessile masses; May have a cauliflower like surface texture or may consist of a finger or hair-like projections; Range in color from white to pink; can be found on the lips or any mucosal surface; most often seen on the soft palate
Distinguishing Characteristics
= Cauliflower-like appearance of oral squamous papilloma suggest infection with HPV
Dental Implications
= Lesion 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 others
Treatment and Prognosis
= Conservative surgical excision, cyrotherapy, or electrodesiccation usually suffices to treat this lesion; risk of reoccurrence is low except an individuals who are immunosuppressed
Condyloma Acuminatum
Etiology
= HPV subtypes 6 and 11
Method of Transmission
= Transmitted by direct contact between the virus and compromised mucous membranes
EO Characteristics
= Lesions can occur on any mucosal surface in the anogenital area; clinical appearance is multiple flat, pinkish, exophytic growths with sessile bases and rough cauliflower-like surfaces
PO and IO Characteristics
= Intro oral lesions can be quite extensive and occur in sites that are frequently traumatized during fellito or cunnilingus, Such as the labial and lingual frenula and the soft palate and oropharynx; Lesions begin as papular growths that in large and coalesce becoming nodular, pink, exophytic growths with a rough papillary surface
Distinguishing Characteristics
= Cauliflower-like appearance of the lesion
Dental Implications
= Infection is more common in immunosuppressed patients; clinician should evaluate patients assessment data for other indications that would call for a medical referral
Treatment and Prognosis
= Oral lesions are usually removed surgically using scalpel, laser, cyrosurgery, or electrosurgery; Reoccurrences are common
Multifocal Epithelial Hyperplasia
Etiology
= HPV’s 13 and 32 have been implicated
Method of Transmission
= by surface contact with the virus through a break in the mucosal barrier; frequently due to localized trauma; usually found in crowded areas such as daycare and school; outbreaks usually involve a large number of children
EO Characteristics
= Not applicable
PO and IO Characteristics
= lesions are pink to whitish, somewhat translucent, surface that is only slightly cauliflower-like; Soft on palpation; most commonly affects the lips, tongue, and buccal mucosa where they appear as numerous discreet papular or nodular growths
Distinguishing Characteristics
= Lesions may be more generalized within the oral cavity
Dental Implications
= None
Treatment and Prognosis
= Treatment is not always necessary; excision can be performed to establish a diagnosis; lesion should resolve spontaneously without any treatment; malignant transformation is unlikely
Inflammatory or Reactive Lesions with a Papillary Configuration
Papillary Hyperplasia
Etiology
= Reactive tissue proliferation due to mild, persistent trauma almost exclusively by the rubbing of an ill-fitting dentures on the mucosa during function
Method of Transmission
= Not applicable
EO Characteristics
= Not applicable
PO and IO Characteristics
= Lesion most commonly appears on the power tool mucosa as a field of pink to bright red, clustered papules that are firm to palpation
Distinguishing Characteristics
= Condition is almost 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 a new denture; should also be educated on the proper use and care of their dentures, including the dentures must be removed from the mouth for a period of time every day
Treatment and Prognosis
= Lesions should not be surgically excised without the fabrication of a new denture, since mechanical trauma related to functioning of an ill-fitting denture will simply result in reoccurrence; Soft tissue and the dentures surface need to be treated with an antifungal agent; prognosis is excellent, as long as the new dentures are fabricated following removal of the lesion and the patient is educated about the upkeep of dentures
Premalignant/Malignant Lesions Associated with a Rough or Papillary Surface
Keratoacanthoma
Etiology
= Exact calls is not clear and its nature is controversial; exposure of the affected area to sunlight is strongly associated with the development of this lesion; other possible factors include the presence of chromosomal abnormality’s in the skin, occupational exposure to tar, a compromised immune status, and exposure to several forms of HPV
Method of Transmission
= None
EO Characteristics
= Arise on the sun exposed skin of the face, neck, and upper extremities; the dome-shaped nodules display a smooth shiny surface with a central crater containing a cord or plug of keratin; rarely seen before age 45; 95% our own son exposed areas of the face and upper or lower lips
PO and IO Characteristics
= Most frequently detected by the dental team on the edge of the Vermilion border of the lower lip
Distinguishing Characteristics
= Has the same characteristics as SCC; need for prompt identification and treatment
Dental Implications
=Observation of this lesion during an EO exam should prompt a medical referral; patient should be educated about prevention and self-examination
Treatment and Prognosis
= Surgical excision is the treatment of choice; treatment should be the same as SCC; prognosis is excellent with complete surgical removal; untreated lesions may leave a scar
Verrucous Carcinoma
Etiology
= Most appear to be related to the use of spit tobacco; mucous membrane exposure to alcohol; several forms of HPV
Method of Transmission
= Not contagious
EO Characteristics
= Not applicable
PO and IO Characteristics
= Early lesions appear as white patches; fully developed lesions appear as cauliflower-like papillary, exophytic appearance that spreads over a large area of the mucosa; can have fissuring and ulceration of the lesions; usually found on the vestibular mucosa, alveolar ridge, gingiva as well as the buccal mucosa
Distinguishing Characteristics
= General appearance coupled with a history of spit tobacco; biopsy should be performed for definitive diagnosis
Dental Implications
= Educate patients about the effects of spit tobacco use and cancel them about tobacco cessation
Treatment and Prognosis
= Surgical removal; cyrotherapy; good prognosis; most patients are free of cancer five years after surgery; if SCC is identified, prognosis becomes less favorable
Oropharyngeal Cancer and Tonsillar Cancer
Etiology
= Studies are conflicting; number of sexual partners appears to increase the chance of infection; alcohol, tobacco, and betel quid chewing are risk factors; oropharyngeal cancer seems to affect a younger population who are less than 50 years old and most are less likely to report alcohol and tobacco use; majority is found on the lateral borders of the tongue and the base of the tongue and floor of the mouth
EO Characteristics
= None
PO and IO Characteristics
= Recognition might be delayed because of the lack of visibility and until there is lymph node involvement, the patient and clinician may not be aware of the infection
Distinguishing Characteristics
= Inflammatory tissue with a papillary appearance; cervical nerve involvement and mandibular lymph node involvement; lesion in the throat or oral tissues that bleeds easily does not heal or a persistent patch, red or white, a lump or thickening, or a neck mass should cause alarm; difficulty in moving the tongue and chewing difficulty
Dental Implications
= Tooth pain, ear pain, and difficulty in eating or swallowing; careful palpation of cervical and mandibular lymph nodes is crucial; teeth can either be restored or extracted if surgery is necessary
Treatment and Prognosis
= Prognosis of a patient who develops oral cancer that has HPV positive has a better prognosis than those who do not
Method of Transmission :
= None
References
Delong and Burkhart pages 379-389