Human Papillomavirus (HPV) is a double-stranded DNA virus with over 200 genotypes, of which a significant number affect the anogenital and oropharyngeal mucosa.
In recent years, its role in oral pathology has gained considerable attention, particularly due to its implication in the development of benign and malignant lesions in the oral cavity and oropharynx.
Dentists and oral medicine specialists must be aware of the clinical spectrum, diagnostic strategies, and oncogenic potential associated with HPV in the oral environment.
High-risk HPV types, especially HPV-16 and HPV-18, are now recognized as major etiological factors for oropharyngeal squamous cell carcinoma (OPSCC).
Conversely, low-risk types like HPV-6 and HPV-11 are often linked to benign proliferative lesions such as squamous papilloma and condyloma acuminatum.
Clinical Presentation of HPV-Associated Oral Lesions
1. Squamous Papilloma
✔ Most common benign HPV-induced lesion in the oral cavity
✔ Frequently associated with HPV-6 and HPV-11
✔ Typically presents as a small, painless, exophytic growth with a cauliflower-like appearance
2. Verruca Vulgaris and Condyloma Acuminatum
✔ Also caused by low-risk HPV types
✔ Larger and often multiple lesions
✔ Can be transmitted via oral-genital contact
3. Focal Epithelial Hyperplasia (Heck’s Disease)
✔ Rare, but typically seen in children and adolescents
✔ Strongly associated with HPV-13 and HPV-32
4. Oropharyngeal Squamous Cell Carcinoma (OPSCC)
✔ Strongly associated with persistent infection by HPV-16
✔ Often affects the tonsillar region and base of tongue
✔ HPV-positive OPSCC tends to occur in younger, non-smoking individuals and has a better prognosis than HPV-negative tumors
Diagnosis and Detection
Diagnosis relies on a combination of clinical inspection and histopathological confirmation. Molecular techniques such as:
✔ PCR (Polymerase Chain Reaction)
✔ In Situ Hybridization
✔ p16 Immunohistochemistry (as a surrogate marker for HPV-driven carcinogenesis)
…are increasingly used for definitive detection and risk stratification, especially in oncological cases.
Clinical Considerations for Dentists
✔ Early identification of suspicious oral lesions is critical.
✔ Dentists play a crucial role in HPV-related cancer prevention through patient education and referral.
✔ HPV vaccination (e.g., Gardasil 9) is recommended for adolescents and adults up to 45 years to prevent infection by oncogenic strains.
✔ Emphasis on safe sexual practices and routine oral screenings is vital.
Conclusion
HPV has transformed our understanding of oral lesions, especially in the realm of head and neck oncology.
Dental professionals are frontline agents in identifying and referring suspicious lesions, promoting vaccination, and educating patients.
Understanding HPV's impact on the oral cavity is not just important for oral health, but also for public health.
📚 Recent Scientific References
- S. Afr. dent. j. vol.72 n.2 Johannesburg Mar. 2017. Human papillomavirus infection of the oral cavity: what the dentist should know.
- JADA Foundational Science 3(C) 100031 - 2024. Detection of human papillomavirus infection in oral mucosal diseases.
- Annals of Oncology 28: 2386–2398, 2017. Human papillomavirus-related oropharyngeal cancer.
