hyperplasia (Heck’s disease), and condyloma acuminatum (Wagner & Villa, 2017). Table 2 describes the location, Table 2: Common HPV-Associated Oral Lesions Type of Lesion Description
appearance, and treatment of common HPV-associated lesions.
Location
Appearance
Treatment
Squamous papilloma
• Surgical excision.
• These raised, often white, lesions have
• The most common benign oral epithelial neoplasm. • Can be found in any age group. • Thought to be caused by HPV type 6 or 11.
• Can be found anywhere in the mouth but
small fingerlike projections that grow outward, resulting in a rough, cauliflower-like appearance similar to that of a common wart. • Average size is less than 5 mm. • They often grow rapidly, then remain stable.
more commonly located on the ventral surface of the tongue and frenum area, palate, and mucosal surface of the lips.
Verruca vulgaris
• Found most often on the keratinized surfaces of the gingiva and palate.
• Surgical excision.
• Known as the “common wart.” • Contagious. • The most common HPV skin lesion, but it can also occur in the mouth. • Typically found in children but can occur in any age group. • Oral lesions are thought to occur via autoinoculation. • Thought to be caused by HPV type 2 or 4. • Rare benign lesion also known as “Heck’s disease.” • Thought to be caused by HPV type 13 or 32. • Frequently affects children but appearance in HIV-positive individuals is increasing.
Focal epithelial hyperplasia
• The lesions can
• Labial, lingual, and buccal mucosa.
• Typically
persist for a period of months, and then resolve with no treatment.
resemble the normal mucosal color but can appear white and rough. • Usually appear as multiple, smooth, dome-shaped growths ranging in size from 3 mm to 10 mm.
• The risk of
recurrence is minimal.
Condyloma acuminatum
• Surgical removal should include excising all lesions simultaneously to avoid chances of autoinoculation. • Topical agents to treat genital and
• Labial mucosa, • soft palate, and lingual frenum.
• Appearance similar to the
• Known as an “STI” since they are commonly found in the genital area. • Occurrence in the mouth is due to oral sex, autoinoculation, or transmission from mother to child. • Left untreated these lesions can cause disfigurement. • Associated with HPV type 2, type 6, and type 11.
papilloma, but lesion is usually larger and more clustered.
anal condylomas are available but have not been approved for oral use.
Note . Adapted from Syrjanen Stina. Oral Manifestations of human papillomavirus infections. Eur J Oral Sci. 2018 Oct;126(Suppl 1): 49-66. https://www.ncbi. nlm.nih.gov>pmc>articles>PMC6174935; Van Heerden, W. F. P., Raubenheimer, E. J. and Bunn, B. K. Human papillomavirus of the oral cavity: what the dentist should know. South African Dental Journal. Vol. 72. n 2. Johannesburg March 2017; Alvarado Juan Mart n Pes ntez, guez Valeria Paulina Romero Rodr, Carrasco Milton Fabricio Lafebre, Ramos Victor Rafael Vazquez and Carrasco Julieta Carmen Reinoso. Squamous papilloma in the oral cavity: case presentation and review of the literature. Journal of Dental Health, Oral Disorders and Therapy. July 3, 2018;9(4):257-260. https://medcraveonline>JDHODT>squamous-pa... Risk factors and at-risk populations
Association, 2022). Among those 50-59, 8.1% and 2.1% of men and 1.6% and 0.5% women harbored the HPV-16 and other oncogenic HPV, respectively (D’Souza, et al., 2017). The higher prevalence of these oncogenic strains of HPV among men in this age range occurred among those who smoked and had a higher number of lifetime oral sexual partners (American Dental Association, 2022).
Oral HPV infections are strongly associated with sexual behaviors and oral HPV prevalence increases with an individual’s number of oral-genital sex partners (WebMD, 2022; Oral Cancer Foundation, 2022). Other studies suggest transmission of the virus through deep kissing (Riddell IV, et al., 2022; Cleveland Clinic, 2022; UCSF, 2019). HPV-16 and other HPV oncogenic genotypes were found in the oral cavity of 3.5% (HPV-16) and 1.1% (other HPV genotypes) of adults in the United States (American Dental
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