Warts can certainly appear on the tongue and other surfaces within the mouth. These growths are generally known as oral warts, but their specific medical term is Oral Squamous Papilloma (OSP). They represent one of the most frequently diagnosed benign tumors of the oral cavity and are typically non-cancerous. While they are common and usually painless, any new growth in the mouth warrants professional examination to ensure an accurate diagnosis.
What Are Oral Warts?
Oral Squamous Papillomas are benign epithelial masses that can develop on any surface of the mouth. They are most commonly found on the soft palate, the tongue, and the lips. Clinically, an oral wart is typically a solitary growth, meaning a person usually has only one lesion at a time.
The defining characteristic of these lesions is their distinct appearance, often described as cauliflower-like or wart-like. They feature numerous small, finger-like projections extending from the surface. These growths usually remain small, often measuring less than half a centimeter in diameter.
The color of an oral wart can vary, appearing white, pink, or tan depending on the degree of keratinization, which is the buildup of a protective protein layer on the surface. These growths can be either pedunculated or sessile. Importantly, they are generally soft to the touch and painless unless they are frequently irritated by chewing or dental appliances.
The Cause: Human Papillomavirus (HPV)
The direct cause of Oral Squamous Papillomas is infection with the Human Papillomavirus (HPV). For oral warts, the low-risk types, specifically HPV 6 and HPV 11, are responsible for the vast majority of cases.
Transmission of the virus to the oral cavity occurs through direct contact. This often involves skin-to-skin or skin-to-mucosa contact, with oral-genital contact being a primary route of transmission for the types causing oral warts. Autoinoculation, where the virus is transferred from a wart elsewhere on the body, such as the hands, to the mouth, is also a possible route.
While HPV 6 and 11 cause these benign lesions, other high-risk types, particularly HPV 16, are strongly associated with a small percentage of oropharyngeal cancers. Even though the virus is present, the vast majority of oral HPV infections are asymptomatic and are cleared naturally by the immune system within one to two years. The development of a visible papilloma is a less common manifestation of the underlying HPV infection.
Identifying and Treating Oral Warts
The process of identifying an oral wart typically begins with a thorough visual examination by a dentist or physician. The characteristic cauliflower-like appearance and location often provide a strong initial clinical diagnosis. However, to confirm the benign nature of the lesion and rule out other, more serious conditions, a definitive diagnosis requires a biopsy.
During a biopsy, a small tissue sample is surgically removed and sent to a laboratory for microscopic analysis. This step confirms the growth is an Oral Squamous Papilloma and not a lesion with malignant potential. Removal is usually recommended for several reasons, including confirming the diagnosis and preventing the lesion from causing discomfort or interference with speaking or chewing.
Treatment Options
Treatment for oral warts is primarily the physical removal of the lesion. Common procedures include surgical excision, where the growth is cut away, often with a small margin of surrounding tissue. Other effective methods include cryotherapy, which involves freezing the wart with liquid nitrogen to destroy the tissue. Laser ablation is another option that uses a focused beam of light to vaporize the lesion.
Regardless of the technique used, the goal is the complete removal of the wart, particularly at its base, to minimize the chance of recurrence. While these treatments remove the lesion, they do not cure the underlying viral infection, meaning new warts could potentially appear in the future.
Distinguishing Oral Warts from Other Oral Lesions
It is impossible to definitively differentiate a benign oral wart from a more concerning lesion based on appearance alone, which is why professional evaluation is necessary. An Oral Squamous Papilloma must be distinguished from other oral growths, some of which may be precancerous or cancerous.
For example, verrucous carcinoma is a low-grade oral cancer that can present with a similar warty or cauliflower-like surface. Another lesion is verrucous leukoplakia, which can also have a rough, white surface but carries a high potential for malignant transformation.
Unlike oral warts, these more concerning lesions often have a larger size, a less defined border, and a firmer consistency. Common canker sores, which are painful ulcers, are easily distinguished from oral warts, which are typically raised, non-ulcerated, and painless bumps. Only a histopathological analysis of a biopsy sample can confirm whether the growth is a benign Oral Squamous Papilloma or a lesion that requires more aggressive management.