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Verrucal Papillary lesions, Sorce of information - Coggle Diagram
Verrucal Papillary lesions
Oral Squamous Papillous (Oral Wart)
HPV 2,6,11 and 57 have been associated with benign oral squamous papilloma. HPVs 6 and 11 re identified most commonly.
HPV is transmitted by direct contact between the virus and nonintact mucosa. They have very low infectivity. The virus can also be spread by autoinoculation (transfer from one site to the next on the same person),
There is no prevalence data for the oral lesion alone; however, 7 to 10% of the population has some form of cutaneous and mucosal HPV. Immunocompromised individuals are at greater risk. Females are more likely to be infected in the genital areas.
Intraoral: Oral squamous papilloma manifests as painless, exophytic, well-circumscribed, pedunculated, sessile masses. The surface exhibits the proliferation of parakeratinized squamous epithelium. finger-like projections. The lesions have a cauliflower-like appearance. Color may be from white to pink and can be found on the lips or any mucosal surface.
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Dental implication: The lesions should be removed because of the association of some forms of HPV with oral malignancies and because the patient may be treatment the causal viral agent to others.
Treatment and prognosis: Conservative surgical excision, cryotherapy, or electrodessication usually suffices to treat lesion. The risk of recurrence is low except in those individuals who are immunocompromised and therefore have a considerably high risk.
Condyloma Acuminatum (Genital or venereal warts)
More than 30 different types of HPV can infect the anogenital tract.
HPV 6 and 11 (low risk) most common. HPV 16 and 18 (high risk) less common.
Transmitted by direct oral–oral or oral–genital contact
An estimate of 2/3 of individuals who have sexually contact with an infected partner will develop gential warts, making it a highly contagious condition.
Extraoral: The lesion can occur on any mucosal surface in the anogenital area. The clinical appearance is of multiple flat, pinkish, exophytic growths with a sessile base and rough cauliflower-like surfaces. Intraoral: lesions can be quite extensive and occur in those sites that are frequently traumatized during fellatio and cunnilingus such as labial/lingual frenula, soft palate, and oropharynx.
Dental implication: Diagnosis and treatment of the condition will help prevent transmission of the virus. This infection is more common in immunocompromised patients, and the clinician should carefully evaluate the patient assessment data for other indication that would suggest the need for a medical referral.
Treatment and prognosis: Oral lesions are usually removed surgically using a scalpel, laser, cryosurgery, or electrosurgery. Recurrences are common. Patient exposed to HPV 16 or 18 in the anogenital area have an increase risk of developing anogenital sarcoma.
Multifactorial Epithelial Hyperplasia (Heck Disease)
HPV 13 and 32 (low risk type) have been implicated in the development of this condition.
Transmitted by the virus through a break in the skin.
All ages are affected, but most often in younger age groups. Both males and females are equally affected.
Intraoral: Lesions appear pink to whitish and somewhat translucent. Surface may be cauliflower-like.
Areas most affected are the lips, tongue, and buccal mucosa. Lesions may appear as numerous discrete papular or nodular growths. They appear more soft since they lack less keratin than other HPV-type lesions.
Dental implication: No dental implications.
Treatment and prognosis: Treatment is not always necessary. Conservative excision may be performed to establish a diagnosis. Often these lesions will resolve spontaneous without any treatment. Malignant transformation is unlikely.
Papillary Hyperplasia (Inflammatory Papillary Hyperplasia)
Papillary Hyperplasia is a reactive tissue proliferation due to rubbing, persistent trauma cause almost exclusively by the rubbing of an ill fitting denture on the mucosa during function
Mode of transmission is not applicable.
Papillary hyperplasia may occur in any age group but typically affects older individuals. The longer the patient has gone without being evaluated, the higher the chance of finding this problem under an ill-fitting denture or partial.
Intraoral: The lesion most commonly appears on the palatal mucosa as a field of pink to bright red, clustered papules that are firm to palpation
Dental implications: Patients who exhibit this condition should be treated with a soft denture reline material prior to surgical removal of the lesion and fabricate a new denture. Patients should be educated on the proper use of and care of dentures, including the fact that the denture should be removed at a certain period every day.
Treatment and prognosis: Other procedures would be to rule out any other possible disease states. Papillary hyperplasia is frequently associated with Candida so treatment for this may be needed. The lesion should bot be surgically remove without the fabrication of a new denture. The prognosis is excellent, once new dentures are fabricated following removal of the lesion and the patient is educated.
Keratoacanthoma
Etiology is unclear. Associative factors: sun exposure/environmental factors, immune concerns, and HPV (9,11,13,16,18,24,25,33,37, and 57).
Occurs more frequently in males.Usually is found on the lower lip but may be also on any sun-exposed skin surface. The peak incidence of the lesion is those over the age of 60 years. It is uncommon in darker skinned individuals.
Intraoral: They are most frequently detected on the vermillion border of the lower lip. These lesions are not found on mucous membrane within the oral cavity.
Dental implication: Observation of the lesion with this general appearance during an extraoral examination should prompt a medical referral by the dental healthcare provider. Additionally, a patient who develops Keratoacanthoma is at a higher risk of nonmelanoma skin cancer.
Treatment and prognosis: The patient should be told about skin cancer prevention and the use of skin protection. Surgical excision may sometimes leave the patient with scarring that may need further plastic surgery to correct the defects. The size of the lesion would determine how extensive the scar would be. Untreated lesions may regress spontaneously but leave a scar. Referral to a medical facility is the best option for the patient.
Verrucous Carcinoma
Most are related to spit tobacco (snuff or chewing tobacco). Alcohol increases the risk.
They are not thought to be contagious, although a variety of HPV have localized within them.
Occurs primarily in males over 55. Usually develop in the area of tobacco placement.
Early lesions appear as white patches, whereas more fully developed lesions display a cauliflower-like papillary appearance. The most common site is the oral pharynx and the tonsil region. Oral complaints include halitosis, stinging, and burning.
Dental implication: Verrucous carcinoma often forms within long standing leukoplakia associated with spit tobacco. The dental hygienist is in an excellent position to educate patients about the effects of spit tobacco use and counsel them about tobacco cessation.
Treatment and Prognosis: Surgical removal is the treatment of choice. A biopsy must be performed to provide a definitive diagnosis with subsequent surgical removal. Cryotherapy (freezing) has a high rate of success when the lesion is well-circumscribed. Metastasis is rare unless squamous cell is identified within the lesion. Smoking cessation and/or spit tobacco education is crucial for the patient.
Oropharyngeal Cancer and Tonsillar Cancer
HPV, sexual practices, and alcohol, tobacco, betel quid use
is associated with this type of oral pharyngeal cancer.
The rate is much higher in males (four time more common in men than women). HPV is a small DNA virus with an affinity toward squamous epithelium. The tonsil crypts provide a perfect location for the virus replication.
Intraoral: May have cervical and mandibular lymph node involvement. A papillary appearance may be a present lesion in the throat or oral tissue that bleeds easily does not heal or a persistent patch, red or white in color. Recognition may be delayed because of lack of visibility, and until there is a lymph node involvement, the patient and clinician may not be aware of the infection.
Dental implication: Tooth pain, ear pain and difficulty in eating or swallowing may be reported. Careful palpation of the cervical and mandibular nodes is crucial. If surgery is needed, teeth may either be restored or in some cases extracted before radiation therapy.
Sorce of information
Delong, L. & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist, Third Edition. Philadelphia: Wolters Kluwer.