Braz J Oral Sci. January-March 2006 - Vol.

5 - Number 16

Oral papilloma in pediatric patients

Francisco Wanderley Garcia de

Paula e Silva1*
Alexandra Mussolino de Queiroz2*
1

DDS, Graduate student

DDS, MSc, Professor
*Department of Pediatric Clinics, Preventive and
Social Dentistry at the Faculty of Dentistry of
Ribeiro Preto, University of So Paulo, Brazil.
2

Abstract
Oral papilloma occurs relatively commonly intra-orally in pediatric
patients who are usually unaware of their presence because this
lesion is usually single, asymptomatic and small. The aim of the
present study is to describe the clinical and histological appearance
of this lesion and provide subside to help the general or pediatric
dentist on diagnosis and treatment of this tumor.
Key Words:
oral papilloma, pediatric patient, dentistry

Received for publication: September 22, 2005

Accepted: February 22, 2006

Correspondence to:
Alexandra Mussolino de Queiroz
Departamento de Clnica Infantil, Odontologia
Preventiva e Social
Faculdade de Odontologia de Ribeiro Preto /USP
Av. do Caf S/N,
CEP: 14040-904 Ribeiro Preto - SP - Brasil.
Phone: +55-16-3602-4116
Fax: +55-16-633-0999
E-mail: amqueiroz@forp.usp.br

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Braz J Oral Sci. 5(16):938-940

Oral papilloma in pediatric patients

Introduction
Papilloma is a benign neoplasia of the stratified squamous
epithelium, which is relatively common in children1-2.
The findings of a study that reviewed data from 2,356
biopsies of young patients (birth to 14 years) received over
15 years in an Oral Pathology Service in Brazil revealed that
papillomas were the most frequently observed benign
tumors of non-odontogenic origin, corresponding to 29.5%
of these lesions 3 . Al Khateeb et al. 4 , in a 10-year
retrospective analysis of the types and distribution of oral
and maxillofacial tumors in north Jordanian children and
adolescents, reported that the papilloma was the most
commonly found benign epithelial tumor in this population.
Das and Das2, after reviewing the results from 2,370 biopsies
of patients up to 20 years of age collected over 11 years in
the biopsy service at the University of Illinois, USA,
reported that the papilloma was the most prevalent oral
neoplasia in this population.
Although its exact etiology is still unknown, it is believed
that the origin of papillomas is related to traumatisms or to
human papillomavirus, especially HPV-6, 11, 16, which have
already been identified in these lesions5. The theory that
associates papillomas to the HPV advocates that this virus
is capable of invading the nuclei of the cells in the spinous
layer, inducing a series of proliferative alterations that result
in tumoral growth6-7.
The papillomaviruses are a heterogeneous group of over
100 deoxyribonucleic acid (DNA) viruses that are
predominantly located in the squamous epithelium, causing
hyperplastic, papillomatous and verrucous lesions in
human and in a wide range of animals5,8.
The possible modes of HPV transmission in children include
vertical transmission, auto and heteroinoculation by genital,
sexual or casual social contact5-6,8-9.
In children younger than 1 year of age with papilloma
lesions, maternal-fetal or maternal-neonatal HPV

transmission is most likely involved. Intrauterine

transmission may occur via hematogenous spread either
due to recent infection or reactivation of a latent infection
of the mother 5-6,10-11 . It has also been suggested that
neonates could acquire the HPV infection due to aspiration
of amniotic liquid as they pass through the vaginal birth
canal during delivery. In children older than 1 year of age,
HPV transmission may occur by both auto and
heteroinoculation6. Moreover, the possibility of childhood
sexual abuse should be considered when other routes of
transmission (i.e., autoinoculation by hand to genital area
and genital area to hand or mouth, nonsexual contact or
perinatal transmission) have been ruled out6.
In the oral cavity, papillomas most commonly occur on the
palate (34%) (Figure 1) and jugal mucosa, but may also
affect the uvula, tongue, lips and gingival1-2. These tumors
are characterized by an exophytic, painless, well-delimited
growth, and the numerous small digitiform projections on
their surface give them a clinical cauliflower-like
appearance1. Papillomas usually manifest as single, whitish
lesions but may have the color of the surrounding mucosa.
Although papillomas are typically small, generally
measuring only few millimeters in diameter, there are reports
of lesions measuring several centimeters12.
Generally, the clinical appearance of oral papillomas is
hardly distinguishable from that of common warts (verrucae
vulgaris). For an accurate differential diagnosis, it is
necessary that any HPV that is normally found in skin
lesions also be identified in the intraoral lesion. The
papillomaviruses present in skin lesions that have been
associated to intraoral common warts are HPV-2 and 575. A
logical association for clinical diagnosis would be to
establish a connection between the presence of common
warts in the childs hands and fingers, habits such as thumbor finger-sucking and onychophagia, and the oral papilloma
lesion6 (Figures 2 and 3).

Fig. 1 - Clinical appearance of an oral papilloma located on the

palate of a 10-year old child.

Fig. 2 - Presence of common warts (verrucae vulgaris) on the thumb

of a child with thumb-sucking habit.

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Braz J Oral Sci. 5(16):938-940

Oral papilloma in pediatric patients

10.
11.

12.

13.

14.

Fig. 3 - Multiple verrucous lesions on the lip and perioral region of

the same patient shown in Figure 2.

The histological examination of these lesions reveals the

proliferation of the spinous layer cells, following a
digitiform pattern with a delicate core of fibrous connective
tissue constituting the supporting stroma 12-13. Variable
degrees of inflammatory reaction can be observed in this
stroma, depending on the existence of epithelial
ulcerations 14.
The treatment consists of complete excision of the base of
the lesion and a small area of surrounding normal tissue
using a number 15 stainless steel scalpel blade 12. The
specimen should be sent for histopathologic examination
to confirm the clinical diagnosis of papilloma and to assure
that the surgical intervention and treatment management
of the pathology were adequately performed.
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