HUMAN PAPILLOMAVIRUS –RELATED ORAL LESIONS IN KUWAIT – CLINICAL CASE SERIES

Human papillomaviruses (HPV) are known to be a causative agent for a number of papillary lesions. The variants HPV-16 and HPV-18 have been linked with cervical, oropharyngeal, and lung cancers. HPV is also responsible for HPV-related oral lesions (HPVOL), which can clinically manifest as squamous papilloma, verruca vulgaris, condyloma acuminatum, and multifocal epithelial hyperplasia. This review paper presents cases of benign oral manifestations of HPV infections in patients attending oral medicine clinics in Kuwait. We present a case series of human papillomavirus-related oral lesions (HPVOL) presented to our oral medicine clinics, with emphasis on the possible risk factors for its increased incidence. Known risk factors for the development of an HPV infection have been highlighted with emphasis on changing sexual practices, smoking, alcohol consumption, and poor oral hygiene in the EMENA region. While the prevalence of oral HPV in men and women aged between 14 and 69 years is around 7%, unsafe sex practice was scored the lowest in Kuwait. Further, there tends to be a higher prevalence of HPV oral infection with smoking and alcohol intake, and both can act synergistically in the presence of an oral HPV infection, further increasing the oncogenic potential of HPVOL. Poor oral hygiene is also a known factor in HPVOL. The role of dental practitioners is to raise awareness of the risk of developing HPV and the preventive measures to reduce that risk. These include engaging in safe sexual practices, smoking cessation, and improving oral hygiene. Incorporating the HPV vaccine into the national immunization scheme could contribute to increase in vaccine uptake and hence better population immunity. The recognition of the clinical presentations of HPVOL as presented herein, facilitates dentists’ diagnostic skills and aids in making appropriate referrals.