Multifocal epithelial hyperplasia (MEH), or focal epithelial hypertension (FEH), or Heck\'s disease, is an uncommon, benign oral mucosal disease associated with human papillomavirus infection. It is mostly observed in indigenous populations of the world, and has been rarely reported in China. However, previous research suggested there might be a greater prevalence of MEH in the Chinese population. While predominantly involves the lips, buccal mucosa and tongue, MEH was occasionally reported to affect the hard palate and gingiva as well.
This paper reports a case of extensive MEH lesions that confined to the interdental papilla of a Chinese male without detection of HPV, and summarizes the published gingiva-involved MEH reports from 1966 until present. The lesions were excised with an Er: YAG laser after scaling and root planning, no recurrence was observed after 6-month follow-up.
The present report illustrates the need for clinicians to be aware of rare presentations of MEH to facilitate a prompt diagnosis and proper management. More reports are encouraged to determine a correct prevalence rate of MEH in China.

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Introduction: Focal epithelial hyperplasia (FEH), also known as Heck\'s disease, is a human papilloma virus induced proliferation of epithelial cells, which causes asymptomatic lesions in the oral mucosa. Heck\'s disease is more prevalent among children or in a family. Despite the self-limitation of lesions, they may progress or cause esthetical and functional discomforts. Hence, early diagnosis is necessary. Case Presentation: A middle-aged man with a peripheral multiple soft, elevated, sessile, smooth, lobulated surface and nodular lesions in his right buccal mucosa was referred. The dimensions of the lesions varied from 5 to 25 mm. Through clinical and histopathological examinations, Heck\'s disease was diagnosed. The diode laser (wavelengths of 980 nm), 1-W power using continuous waves) was applied serially (in 2 sessions with a 1-week interval) for surgically removing the lesions. The patient was followed up for 6 months with no lesion recurrence, and gradual healing was observed. Conclusion: The laser is an effective treatment with no scar remaining after the procedure and brings satisfaction to patients.

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Heck\'s disease or focal epithelial hyperplasia is a rare, benign and asymptomatic lesion of oral mucosa that is characterized by the presence of soft, sessile papules, white to pinkish in colour that occur diffusely in oral cavity. Prevalence rate of this disease greatly varies from one geographic region to another. It is found to be closely associated with human papilloma virus (HPV). This paper reports an Indian case of focal epithelial hyperplasia in a 5-year-old boy that is diagnosed according to both clinical and histopathological features, where human poillomavirus (HPV) subtype 32 was found associated with disease through polymerase chain reaction analyses. A dental practitioner should be aware of this disease and must perform a careful evaluation both clinically and histopathologically for setting the diagnosis with other diseases.
UNASSIGNED: Nallanchakrava S, Sreebala N, Basavaraj, Sindgi F. Laser Excision of Focal Epithelial Hyperplasia (Heck\'s Disease): A Rare Case Report. Int J Clin Pediatr Dent, 2018;11(6):526-528.

Oral verruca vulgaris is caused by human papillomavirus (HPV) infection. Verruca vulgaris most frequently occurs on the fingers, toes, soles, and dorsal surfaces of hands and is mostly asymptomatic. Varieties of verrucous and papillary lesions affect the skin as well as oral mucosa which may be either benign or reactive. Common wart is one of the most commonly observed skin growths and a lesion of childhood. Intraoral warts can occur at any age with equal incidence in both genders but are most commonly seen in the third to fifth decade. It is found commonly on the palate followed by lip, tongue, buccal mucosa, and rarely seen on gingiva. Surgical excision with adequate margins is the treatment of choice.

Focal epithelial hyperplasia (FEH), or Heck\'s disease, is an uncommon benign proliferation of oral mucosa caused by the human papillomavirus (HPV), particularly subtypes 13 and 32. The disease typically presents in young Native American patients and is characterized by multiple asymptomatic papules and nodules on the oral mucosa, lips, tongue, and gingiva. The factors that determine susceptibility to FEH are unknown, but the ethnic and geographic distribution of FEH suggests that genetic predisposition, particularly having the human lymphocytic antigen DR4 type, may be involved in pathogenesis. We report a case of FEH with polymerase chain reaction detection of HPV13 in a healthy 11-year-old Hispanic girl and discuss the current understanding of disease pathogenesis, susceptibility, and treatment.

Focal epithelial hyperplasia (FEH), or Heck\'s disease, is a rare disease of the oral mucosa associated with infection by some subtypes of human papilloma virus, especially subtypes 13 or 32. The disease is predominantly found in children and adolescents with indigenous heritage, but other ethnic groups can be affected worldwide. To the best of the authors\' knowledge, it has not been reported in Brazil\'s elderly population. This article describes a case of FEH in a 57-year-old Brazilian patient presenting since childhood, with multiple lesions in the lips, buccal mucosa and tongue. The solitary tongue lesion underwent excisional biopsy and the histopathological analysis showed parakeratosis, acanthosis, rete pegs with a club-shaped appearance, koilocytosis and the presence of mitosoid cells. These microscopic findings in conjunction with clinical presentation were sufficient to establish the accurate diagnosis of FEH. Polymerase chain reaction (PCR) was performed, but no one human papillomavirus (HPV) subtype could be identified. Clinicians must be aware of this rare oral disease, which can even affect elderly patients, as we described here. Treatment may be indicated in selected cases due to esthetic and/or functional problems.

Focal epithelial hyperplasia (FEH) or Heck\'s disease is a rare viral infection of the oral mucosa caused by human papilloma virus especially subtypes 13 or 32. The frequency of this disease varies widely from one geographic region and ethnic groups to another. This paper reports an Iranian case of extensive focal epithelial hyperplasia. A 35-year-old man with FEH is described, in whom the lesions had persisted for more than 25 years. The lesion was diagnosed according to both clinical and histopathological features. Dental practitioner should be aware of these types of lesions and histopathological examination together and a careful clinical observation should be carried out for a definitive diagnosis.

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