Oral Pathology

What Is An Oral Pathology?

Oral and Maxillofacial pathology includes any abnormality found in the soft (skin, gums) or hard (bone) tissue of the face. The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Oral pathology can occur on the lips, tongue, cheeks, and floor of the mouth. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. Abnormal cells can also grow in the jaw bones as well. These may be benign, malignant, slow-growing or aggressive in nature. Oral pathology can be acquired or congenital.

Benign facial tumors, though generally non-threateningly, may grow large and require removal of a portion of the jaw. Malignant mouth tumors almost always spread into the jaw, requiring removal of a section of the jaw. In both cases, reconstructive bone grafting is usually required to help restore function to the jaw. Grafting in patients with malignant tumors may be more challenging because treatment of the cancerous tumor generally requires removal of surrounding soft tissue as well.

How Do You Prepare For A Biopsy?

First, a consultation is made to evaluate the lesion and the extent of it. A biopsy may be performed on the same day if possible. Just like any other surgery, you should not take any NSAIDs or foods that thin out blood 10 days prior to your biopsy appointment.

Why Is Screening For Oral Cancer Performed?

The following can be signs at the beginning of a pathologic process or cancerous growth:

  • Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth.
  • A sore that fails to heal and bleeds easily.
  • A lump or thickening on the skin lining the inside of the mouth.
  • Chronic sore throat or hoarseness. Difficulty in chewing or swallowing.

These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face and/or neck. Pain does not always occur with pathology and is often not associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.

Diagnosis

Pathologies in the soft tissue are usually first seen by your dentist or hygienist. You are then referred to an oral & maxillofacial surgeon for evaluation. A differential diagnosis will be made by your surgeon. At this point, a panoramic radiograph, MRI or a CT scan may be required. A biopsy will be performed as soon as possible.

Some of the common pathologies seen in our office:

Viral: Herpes virus can cause sores in the mouth and lips. These sores last from 10-14 days.

Fungal: The most common fungal infection is oral candidiasis. This condition is caused by a decrease in immune system or prolonged usage of antibiotics.

Traumatic: Rough edges from broken down teeth may cause sores on the side of the tongue.
Aphtous ulcers (canker sores): These are usually found in the mouth after surgery. They are most likely linked to stress.

Geographic tongue: Fissures are seen in the tongue. Areas that are involved appear red with white borders.

Mucocele: This is a benign tumor commonly found on the lower lip. There are major and minor salivary glands in the mouth. The saliva is pushed through the oral cavity by tiny canals. If there is trauma or obstruction, the saliva builds up in a sac, appearing as a purplish color lesion. Usually, this lesion changes in size and occasionally bursts. Treatment involves the removal of the mucocele and the salivary glands involved. The procedure length is about 15 minutes and done under local anesthesia. Few resorbable sutures are then placed to assist healing. Soft diet is required for 5-7 days post surgery.

Osteomyelitis: This is a type of bacterial infection in the bone and bone marrow of the jaw. The infection leads to inflammation, which can cause a reduction of blood supply to the bone. Treatment for osteomyelitis generally requires antibiotics and removal of the affected bone. A bone graft procedure may then be required to restore bone function and growth lost during removal.

Periodontal diseases: These diseases are ongoing infections of the gums that gradually destroy the support of your natural teeth. Periodontal disease affects one or more of the periodontal tissues: alveolar bone, periodontal ligament, cementum, or gingiva. While there are many diseases which affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal issues. They are divided into two categories: gingivitis and periodontitis. While gingivitis, the less serious of the diseases, may never progress into periodontitis, it always precedes periodontitis.

Periodontitis: This is affected by bacteria that adhere to the tooth’s surface along with an overly aggressive immune response to these bacteria. If gingivitis progresses into periodontitis, the supporting gum tissue and bone that holds teeth in place deteriorates. The progressive loss of this bone, the alveolar, can lead to loosening and subsequent loss of teeth.

What Can You Expect During An Oral Pathology?

The only way to fully diagnose an abnormality in the tissue is to perform a biopsy and send it to the laboratory. Our oral pathologist will look at the tissue under a microscope and derive a diagnosis. This usually takes 4-5 business days.

The biopsy is performed under local anesthesia. In general, there are 2 types of biopsies that are done in the mouth:

  1. Excisional biopsy: If the lesion is small enough, the lesion can be removed in its entirety.
  2. Incisional biopsy: A small section of the tissue is taken and sent to the laboratory. The extent of the surgical removal is based on the biopsy results.

What Is The Followup And Recovery Like For An Oral Screening?

In general, any lesion in the mouth that is abnormal and does not disappear in a period of 2 weeks should be biopsied. Some lesions, like aphthous ulcers or ulcers from HSV, disappear after 10 days. Superlative treatment is necessary in that period.

If a biopsy is performed, we recommend staying on liquid to soft diet for a week or so. Any surgery performed on mucosa would take 2 weeks for it to become strong again.

We recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body’s most important warning systems. Do not ignore suspicious lumps or sores. This is particularly important if you drink once a day and are a smoker. Please contact us so we may help.

What Are The Potential Costs?

This really depends on the type of pathology and the extent of the surgery. Usually, removal of any lesion that is related to the gums or teeth is submitted to your dental insurance. Lesions located elsewhere in the mouth or on the skin is submitted to medical insurance.

What Are The Potential Risks?

Most of the lesions in the mouth are not painful. Therefore, the patient would not find out about it until informed by a GP or an OMS doctor. If left untreated, some of these lesions, particularly in bone, can be devastating even if they are benign in nature.

Oral cancer is obviously even more senior. There are more than 500,000 new cases found worldwide. These cases are often found in the later stages of the cancer. 43% of diagnosed cases will not survive past 5 years.

Meet Dr. Majid Jamali

Dr. Jamali, a board-certified oral and maxillofacial surgeon, practices a full scope of oral and maxillofacial surgery with expertise ranging from dental implant surgery and wisdom tooth removal to corrective jaw surgery. This also includes techniques designed to rebuild bone structure with minimal surgical intervention and optimal patient comfort. We can also diagnose and treat facial pain, facial injuries, and fractures. Learn More »

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