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What Is Oral Pathology?

If you have a lump, bump, swelling, or other unusual finding in your mouth or jaw, this unusual finding is generically referred to as oral pathology.  The term oral pathology isn’t describing one specific thing, but rather, it’s a broad term to mean something just isn’t right in your mouth or jaw.  Before reading any farther or getting deeper into the discussion, you should know that something “not being right” does not necessarily mean that something is “wrong.”  While some bad things like tumors need to be considered from time to time, most oral pathology is not serious and of little concern.  Even though most oral pathology is of little concern, an unusual finding in the mouth shouldn’t be ignored, even if it isn’t hurting, bleeding, or causing any other problem.  Instead of ignoring the oral pathology problem, an examination by a qualified dental or medical professional is needed along with a plan to figure out what the oral pathology actually is.  So, what constitutes a plan you ask?  If the qualified health care professional knows what your oral pathology is, your plan may only involve a discussion about the area so that you understand your particular situation.  If the qualified health professional thinks he/she knows what your oral pathology is but isn’t certain, your plan may include having you return in a couple weeks so that the area can be re-evaluated.  Re-evaluation may involve a close look at the area and x-rays depending on your particular situation.  If the qualified health care provider doesn’t know what the oral pathology is, or if he/she has concern about the area, your plan would likely involve a biopsy (tissue sample) of the area.  Read on to find out more information about what a biopsy is and where you can go to get a biopsy if needed.

Where Do I Get A Biopsy?

So, something isn’t right in your mouth or jaws...what should you do.  Most oral pathology specimens are biopsied by dentists or dental specialists.  The common dental specialties that perform biopsies include: nearly all oral and maxillofacial surgeons (oral surgeon), most periodontists (gum doctors), and some endodontists (root canal specialists).  Other medical providers may also perform biopsies for oral pathology specimens including:  otorhinolaryngologists (ENT docs) and dermatologists (skin doctor).  If trying to decide where to go for a biopsy, we’d recommend starting a discussion with the dental or medical provider you have the longest and most in-depth relationship with.  If this provider performs biopsies, maybe you don’t have to look any further.  If this provider does not perform biopsies, get a referral to from that person to another specialist.  At Oral Pathology Consultants, we do not perform biopsies.  Most oral pathologists (short for oral and maxillofacial pathologists) spend time teaching in an academic setting, like dental school for example, and/or looking through a microscope to make a diagnosis of an oral pathology tissue biopsy specimen.  Oral pathologists work closely with all kinds of health care providers to figure out what the oral pathology specimen really is.  So now that you know where to go for a biopsy, you may want to better understand what a biopsy is.

What Exactly Is A Biopsy?

In some ways, trying to explain what a biopsy is and what you should expect during a biopsy is difficult because there are many different kinds of biopsies.  Specific types of biopsies depend on the biopsy location and tissue type.  If we consider the entire body for a moment, not just the mouth, this makes sense.  Bone is very different from soft tissue for example, and brain tissue is very different from the liver.  Each of these individual tissue types is handled and biopsied differently.  Even within the mouth where oral pathology is found, the tissue is very different from location to location.  Due in part to the location of the abnormal tissue in your mouth or jaw, the way tissue is removed from the body will vary.  Biopsies can be performed with a scalpel, laser, soft tissue punch, needle core, and fine needle.  Gentle scrapings of unusual tissue, which are not technically biopsies, can also be done to remove and look at individual or groups of cells.  The most commonly known tissue scraping is the cervical smear or pap smear.  Depending on many factors, the type of biopsy will depend on the location, the tissue type (hard tissue or soft tissue for example), and the skills of your health care provider.  Lastly, when talking about the complexity of biopsies, it should be noted that abnormal tissue can either be completely removed (excisional biopsy) or a small piece of the abnormal tissue can be removed (incisional biopsy).  There are many factors that determine if an incisional biopsy or an excisional biopsy should be performed, but size of the abnormal tissue is one of the biggest factors.  So now that we are past the difficult part of explaining a biopsy, let’s move on to the simple explanation for a biopsy.  A biopsy is a piece of tissue that is removed from the body, preserved in special solution so that the tissue doesn’t degrade, and sent to a lab for tissue processing and histologic evaluation (microscopic diagnosis).

What Should I  Expect During A Biopsy?

We’ve discussed what a biopsy is and who can perform a biopsy.  The next thing nearly all patients want to know is what to expect during a biopsy.  Much like explaining what a biopsy is, this can be a difficult and lengthy discussion because each situation is different.  Most biopsies, however, follow a few common features.
 - Anesthetic – Your biopsy shouldn’t be painful.  Local anesthetics (numbing medicine) is safe, easy to place around the biopsy site area, and very good at keeping you comfortable.
 - Clean and safe – Some biopsies are very simple and some are more challenging, but overall biopsies are incredibly safe.  Health care offices around the country take great care in complying with State and Federal patient safety laws, ensuring a clean and safe experience.
 - Quick – Because anesthetic works so quickly, and most areas in the mouth are pretty easy to get to, a biopsy may take just a few minutes of time.  In fact, the office paperwork in some instances will take longer to complete than the biopsy procedure itself.
 - Stitches – Not all biopsies will result in stitches, but most will.  Stitch types vary, but often resorbable stitches will be put in place so that they will fall out on their own after several days.  Alternatively, you may end up with another type of stitch that will require removal by a health care provider at a follow-up visit.
 - Pain, redness, and swelling – It’s probably no surprise that removing a piece of the body will result in some pain, redness, and swelling.  The area may bleed for a little bit as well.  These signs and symptoms are usually fairly mild, and will vary from situation to situation.  Your health care provider will discuss your situation with you and if necessary, provide options to help control bleeding, swelling, and pain.
 - Healing period of 7-10 days in most situations – The healing capacity of the body is quite amazing, and most biopsies will be fully healed in 7-10 days.  Biopsies of areas inside the bone (upper or lower jaw) will heal slower, and will likely take months for the bone to fully heal.
 - Biopsy sent via courier, FedEx, or other method – If your biopsy is done in the hospital, it will be walked to the pathology lab which is a standard department in most hospitals.  If your biopsy is performed in a stand-alone office, a dental office for example, your biopsy will be sent to a pathology lab via courier, FedEx, or other method.

At Oral Pathology Consultants, we offer complimentary next day FedEx mailers with all of the health care providers we work with.  On rare occasions patients will ask to drive their biopsy to the lab, but this shouldn’t ever be allowed.  Deliveries of this nature should be handled by professionals.

Anything Else I Should Know?

One more thought regarding biopsies... some medical providers can offer IV sedation (light sleep) during the biopsy procedure.  In more difficult biopsies, such as those performed on medically compromised individuals or seriously ill individuals (a serious heart condition for example) a biopsy may be performed under general anesthesia in a hospital setting.  Before you undergo any procedure, talk with your health care provider to discuss risks and benefits of the procedure as well as what may happen if a biopsy isn’t done.  It is pretty clear in most cases of oral pathology that an area either needs to be biopsied or does not need to be biopsied.  Occasionally, there are cases that require more thought and close discussion between the patient and the doctor before a decision to biopsy is made.

What Is Oral Pathology Consultants Role in the Biopsy Process?

So, after all of this you may be wondering why this article is spending so much time talking about biopsies if Oral Pathology Consultants doesn’t perform biopsies.  At Oral Pathology Consultants, Dr. Brent Accurso and Dr. Brent Martin make diagnoses after looking at a tissue biopsy under a microscope.  They receive biopsies, usually via FedEx as described earlier, from all over the United States.  The vast majority of the time,  the biopsy specimens Dr. Accurso and Dr. Martin look at are benign (nothing to worry about) but sometimes they are premalignant (precancerous) or malignant (oral cancer for example).  For strange or rare oral pathology cases, further investigation of the tissue biopsy sample including special studies might be necessary to make a diagnosis.  Because of the complexities involved with examining the tissue, ordering the right special studies, and ultimately assigning a diagnosis, oral and maxillofacial pathologists are highly trained.  It is not uncommon for oral and maxillofacial pathologists to work closely with other dental specialists such as oral radiologists, oral medicine doctors, oral surgeons, periodontists, etc., to get the right diagnosis.

To understand more about the field of Oral and Maxillofacial Pathology (Oral Pathology for short), click below.