Papillary (pebbled) masses of the oral mucosa: more than simple papillomas

Soft tissue masses are found in almost 4% of adult dental patients, and most of these will never be biopsied. Clinical evaluation, therefore, is of paramount importance. Oral mucosal masses with irregular or nodular surface alterations are of special concern. These alterations may appear to be papillomas, but there are several type of papillomas, and among the lesions which present with a papilloma-like appearance are diverse malignancies, contagious infections, sexually transmitted diseases, vascular and reparative lesions, and viral proliferations associated with a wide range of different types of human papillomavirus. The learning objective of this article is to present a clear, clinically oriented approach to the diagnosis and management of pebbled and lobulated intraoral masses, enabling the clinician to provide a more meaningful clinical diagnosis and prognosis. For the differential diagnosis discussion, the authors have selected only those entities with the preliminary diagnosis of "papilloma."