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Mark Bornfeld, DDS
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 6009
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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I recently discovered this cluster of 3 raised flat papules

Customer Question

Hi,
I recently discovered this cluster of 3 raised flat papules on my hard palate near the rugae. I have sent myself into a tail spin of panic convinced they are warts. Any thoughts on what these may be?
Submitted: 1 year ago.
Category: Dental
Expert:  Dr. Behere replied 1 year ago.

Thanks for uploading the photos and saving time.

They are not warts. Rather than flat papules, they look like small ulcers to me, resembling apthous stomatitis minor ulcers, commonly called as canker sores.

They are too tiny to be painful though.

They are not dangerous, need no investigations/tests and no second opinion. They will resolve on their own in a weeks time.

Hope this answersthis answers your question. Please leave a positive rating if my answer has helped you.

I do not get credit for it otherwise!

Regards,

Dr Behere

Customer: replied 1 year ago.
Canker sores are generally inwards though with a red border and white inside, no? These are definitely slightly raised and flat and the cluster of 3 makes me suspicious. I do have a wart on my finger and have been paranoid about spreading it.
Expert:  Dr. Behere replied 1 year ago.

Hello,

Canker sores don't always follow the classical description. From your photos, It really doesn't appear that they are raised.

And anyways, even if they are not canker sores , they are not warts for sure because warts are discoloured, and intra oral warts rarely occur in groups.

Don't worry, whatever u have, is not dangerous at all.

Hope this answers your question. Please leave a positive rating if my answer has helped you.

I do not get credit for it otherwise!

Regards,

Dr Behere

Customer: replied 1 year ago.
I should add this summer this raised flat bump appeared on my lip also and is still there. If poked it bleeds quite easily, so I also think this is a wart (excuse my invisaligns)
Expert:  Dr. Behere replied 1 year ago.

We can keep going back and forth, I can keep seeing those are not warts, and you can say they are. But that won't get us anywhere.

I'll opt out instead, so that you can get an expert to agree with u and call them warts.

Regards,

Dr Behere

Expert:  Mark Bornfeld, DDS replied 1 year ago.

I'd like to offer an alternative view-- especially since you seem to be relatively informed about the more common types of oral lesions.

The fact is that the lesions on your palate are too early in their stage of development to determine whether they are HPV (human papilloma virus) related lesions based on appearance alone. In the mouth, the most common HPV lesion is more properly called a "squamous papilloma" rather than a wart, but for purposes of discussion it need not matter.

The more salient points follow. First: a papilloma needs to mature a bit before it displays its more characteristic appearance, and your lesions have not yet reached that stage. It is true, however, that the posterior hard palate and soft palate are common sites for papilloma.

There are perhaps over 100 different strains of HPV, and the various strains show a predilection for different anatomic areas and tissues. The most important strain in terms of health significance is HPV-16, which is associated with cancers in the mouth, oropharynx, genitalia, and vaginal cervix. Having said that, HPV-16 is also associated with non-cancerous lesions, so the factors that determine the type of lesion it may cause may be related to host physiology in addition to serotype characteristics of the virus.

Because a majority of squamous papillomas are relatively trivial, they are not always treated aggressively. Likewise, an early lesion that may suggest HPV (as yours may) will not necessarily call for active intervention, although there is some variance in how a particular clinician will treat this. Unlike viruses in the herpesvirus group (e.g., HSV, VZV, EBV, or CMV), HPV is not recognized to cause a persistent infection, and most patients with normal immunity will clear the virus within a year or two.

Just what you do going forward should be decided by a collaborative discussion with your dentist. Most general dentists will refer their patients to an oral surgeon for more formal evaluation, because this specialist will have more familiarity with soft tissue lesions. The only definitive way to identify these lesions, particularly at this early stage, would be biopsy. Your oral surgeon may instead choose to simply keep the lesions under active surveillance, and deferring any decision regarding removal until the clinical behavior of these lesions can be more completely observed.

Hope this helps...

Customer: replied 1 year ago.
Thank you very much! That did help.
Expert:  Mark Bornfeld, DDS replied 1 year ago.

You're very welcome. Good luck!