Oral papilloma are mature benign neoplasms that develop from the cells of the superficial epithelium. When examined on the mucous membrane, single or multiple painless growths on the leg of a mildly elastic consistency of pale pink or whitish color are determined. The general condition is not disturbed. The diagnosis of “papillomas of the oral cavity” is made on the basis of complaints, anamnesis of the disease, data from clinical and histological research methods. Treatment of oral papillomas is surgical – the neoplasm is excised within healthy tissues. When viral etiology is detected, antiviral, immunomodulatory therapy is prescribed.
Meaning
Oral papilloma is the most commonly diagnosed true benign tumor from a multilayered squamous epithelium. The main group of patients are women (in 60% of cases) aged about 40 years. In 20% of cases, oral papillomas are detected in adolescents. Among children, benign education occurs in the age group from 7 to 12 years. In girls, oral papillomas are diagnosed 1.9 times more often than in boys. In adults, in most cases, single papillomas are detected, whereas in childhood papillomatosis (multiple neoplasms) prevails. In 50% of the examined patients, oral papillomas are localized on the tongue. Human papillomavirus (6, 11 types) causes the formation of papillomas in 55-70% of cases.
Causes
Benign tumors of the superficial epithelium of the oral cavity in most cases arise as a result of exposure to human papillomavirus – HPV-6, 11 types. Infection occurs through direct contact with the patient. A neoplasm develops against the background of neutralization of the activity of tumor suppressor genes. The pathogenetic mechanism is triggered after HPV groups penetrate and infect the cells of the basal layer of the epithelium, as a result of which the regulatory processes of cell proliferation are disrupted.
Local predisposing factors are micro-injuries of the mucosa, the depth of which reaches the basal layer. The introduction of single viral particles is sufficient for the development of the infectious process. The process of reproduction of daughter DNA molecules on the basis of the parent occurs exclusively in the basal layer of the integumentary epithelium. As a result of infection, the mechanism of cell differentiation is disrupted. Since HPV is a weak antigen, the synthesis rates of endogenous interferon are reduced. There is a deficiency of cellular immunity.
Multiple papillomas of the oral cavity occur as a result of chronic damage to the mucous membrane by the sharp edges of destroyed teeth, the unpolished basis of a removable prosthesis. In children with a shortened frenulum of the tongue, papillomas of the oral cavity are often diagnosed as a result of injury to the frenulum by the lower incisors.
Microscopically, the papilloma of the oral cavity is a tumor consisting of a highly differentiated multilayer flat epithelium with signs of keratinization. The integrity of its own membrane, cell polarity, and complexity are preserved. The ratio of the structural components of the epithelium and stroma is broken. Focal inflammatory infiltration may occur in places.
Classification
In dentistry, there are single papillomas of the oral cavity and multiple neoplasms – papillomatosis. According to the nature of the etiological factor , papillomas of the oral cavity are divided into 3 groups:
- Traumatic (reactive). Occur as a result of exposure to mechanical, chemical or temperature stimuli. A distinctive feature of papillomas of the oral cavity of reactive origin is the stopping of their growth after the elimination of the causal factor.
- True (neoplastic). They develop due to violations of the mechanisms of control of division, growth, differentiation of cells. It is more often diagnosed in the distal areas of the cheeks, in the retromolar zone, closer to the pterygomandibular fold.
- Viral. Occur as a result of infection with the human papillomavirus. HPV infection occurs after contact with a sick person. If the integrity of the mucous membrane is violated, the gates open for the introduction of viral particles.
Symptoms
Papillomas of the oral cavity are an overgrowth of a rounded mucosa on a leg with a fine-grained, folded or warty surface. The base of the neoplasm can be thin or wide. The mucous membrane around the base of the papilloma is pale pink, without visible pathological changes. On palpation, benign neoplasms of a mildly elastic consistency, painless. The mucosa covering the tumor may have a pale pink or whitish hue, which is associated with keratinization of the epithelium as a result of maceration by saliva.
The size of the papilloma varies from 0.2 to 2 cm. There are both single and multiple neoplasms. The favorite localization of papillomas of the oral cavity are the tongue, hard and soft palate. Less often, a tumor is diagnosed in the cheek area, in the area of the bottom of the oral cavity or in the retromolar zone. Multiple papillomas of the oral cavity are more often detected in the palate. After biting with teeth, the papilloma bleeds, as a result of injury it acquires a dark color, which is caused by hemorrhage into it.
Papillomas of the oral cavity are characterized by a slow exophytic type of growth. The skin is not changed in color. Mouth opening is free. Regional lymph nodes are not palpated. The general condition of the patients is not disturbed. In the case of chronic trauma, areas of ulceration appear on the surface of the papilloma, which may signal malignancy of the neoplasm.
Diagnostics
Diagnosis of oral papilloma is based on patient complaints, medical history, and clinical examination data. Accurate confirmation of the diagnosis can be obtained after a histological examination. During a physical examination, the dentist reveals an overgrowth in the form of a rounded nodule of whitish or pale pink color on the oral mucosa without signs of an inflammatory process. During palpation, papillomas of the oral cavity are painless, of a soft consistency. The general condition of the patients is not disturbed.
With the viral etiology of oral papillomas, the human papilloma virus of 6, 11 types is detected using the DNA hybridization method. PCR diagnostics can confirm the presence of human papillomavirus in the body, as well as determine its type and quantitative composition. The results of histological examination of the material obtained during the surgical intervention are decisive in making the final diagnosis. With papillomas of the oral cavity, cell polarity, stratification, and the integrity of its own membrane are preserved in the epithelium. Cellular atypism is poorly expressed. Along with the proliferation of the spiny epithelial layer, there are phenomena of hyperkeratosis in combination with acanthosis. Hyperplasia of the basal layer is observed. Mitotic activity increases. The number of capillaries in the connective tissue increases.
It is necessary to differentiate papillomas of the oral cavity from fibroids, Serre glands, warts, hyperplasia of the mucous membrane as a result of somatic pathology. The examination is carried out by a dental surgeon. If signs of malignancy are detected, additional consultation with an oncologist is necessary.
Treatment
Treatment of oral papilloma is surgical. Surgically excise the neoplasm within healthy tissues. Methods of electrocoagulation, cryosurgery, and sclerosing therapy are rarely used, since after their implementation it is impossible to conduct a histological examination of the removed material. With multiple papillomatous neoplasms, a combined technique is used: the largest number of grouped papillomas are excised with a scalpel, single neoplasms are removed by electrocoagulation.
In case of oral papilloma of viral etiology, along with surgical treatment, antiviral and immunomodulatory therapy is prescribed. A drug based on inosine, a synthetic derivative of purines, has pronounced antiviral and immunostimulating effects.
As a result of the high mitotic activity of true oral papilloma after surgical treatment, the risk of tumor re-formation is high. If the neoplasm has arisen as a result of traumatization of the mucosa, the elimination of local irritating factors reduces to zero the likelihood of subsequent relapses.