Oral Squamous Papilloma on the Tongue of a 12-Year Old Female: Report of a Case with Human Papilloma Virus Literature Review

Human papillomavirus (HPV) infection that causes squamous papilloma is common in the oral cavity of adults but not in children. Although benign, the slow progressive growth is a concern to clinicians and parents as the lesion may clinically appear as an exophytic verrucous carcinoma or squamous carcinoma. This case report describes a squamous papilloma arising on the tongue of a 12-year old child.


Introduction
Human papillomavirus (HPV) are slow, benign proliferations of stratified squamous epithelium frequently observed in the oral cavity that are the viral etiologic agent for squamous papilloma [1,2]. Squamous papillomata are commonly observed in adults 30-50 years of age and is the fourth most common oral mucosal lesion in both children and adults [3]. Although the entire oral cavity may be affected, the viral lesion has a predilection for the laryngotracheobronchial complex in children and the lower lip, hard and soft palate of the maxilla and uvula in adults [1,[4][5][6]. Clinically, the lesion appears as an exophytic mass and may cause anxiety to the clinician and parents, as the lesion can clinically appear like an exophytic verrucous carcinoma, squamous carcinoma or condyloma accuminatum [1,4,7,8]. This case report describes a squamous papilloma arising on the tongue of a 12-year old child.
Case Report lesion has been present for at least six months. Her past medical history was unremarkable. She was not taking any medications and denied any allergy to medications. The patient also denies being sexually active. Sexual abuse was also ruled-out. Head and neck examination were negative for palpable neck masses and lymphadenopathy. Oral examination of the dorsal surface of the tongue revealed a pink-white colored exophytic lesion that was freely movable. The surface texture had a pebbly appearance that

Discussion
In children, viral transmission remains controversial. HPV transmission may occur by any number of different mechanisms, such as autoinoculation, heteroinoculation, perinatal transmission, sexual abuse and contact with fomites [1,4,5,9,10]. However, trauma is one mechanism that should be considered in our patient.

Iatrogenic tongue biting may initiate an infection of the basal
squamous epithelial cells that allows the entrance of the HPV into the tongue. Viral DNA then enters the nucleus of the infected epithelial stem cells and can replicate causing the HPV infection [15]. low, a bimodal distribution is observed. The highest prevalence is observed in children less than 1 year of age and the second peak occurs in adolescents, between 13 to 20 years old [9,16]. Despite the bimodal distribution, oral HPV infection is considered low in children [17]. In a study of 4140 children between the ages of 10 to 18 years old, the prevalence of oral HPV infection was 1% and the most common type was HPV 11 [18]. Treatment of HPV is by surgical excision [19]. Control, 2019) [20]. To obtain the greatest clinical efficacy and cost effectiveness of vaccination, the Center for Disease Control (CDC) recommends that both male and female children between the ages of 11-12 years get two HPV vaccinations six months apart before individuals have been exposed to the human papillomavirus. It is also recommended that adult women up to age 26 years and men up to age 21 years also obtain the HPV vaccine [21].

Conclusion
A case of oral squamous papilloma on the tongue of a 12-year old female is presented to create awareness of this soft tissue lesion in the oral cavity of children due to the human papillomavirus. It is only after educating clinicians and parents about the HPV will we observe greater identification, management and treatment in the HPV infected child.

Interventions in Pediatric Dentistry
: Open Access Journal