Oral mucosal warts are a rare manifestation of human papillomavirus (HPV) infection in children. We report a 7-year-old Sudanese female with persistent multifocal oral warts resistant to medical therapy. Histopathology confirmed HPV-related verruca. Due to limited molecular resources, HPV DNA PCR and genotyping were not performed, representing a study limitation. The patient underwent complete lesion removal using electrocautery under general anesthesia followed by adjuvant acitretin (0.4 mg/kg/day), cautious reintroduction of topical imiquimod, and zinc supplementation. Sustained remission was achieved at 24 months without recurrence or scarring. This case highlights the value of combining surgical debulking with structured immunomodulation in refractory pediatric oral HPV lesions.