Oral Pathology and Biopsy
SOFT TISSUE PATHOLOGY
The inside of the mouth is normally lined with two types of epithelium. The tissue that lines your cheek, the floor of your mouth, and throat, is a non-keratinized mucosa that is designed to stretch. The tough, immovable tissue that is smooth and coral pink in color and surrounds each tooth and the roof of your mouth, is a keratinized type of mucosa referred to as gingiva (your gums). Any alteration in the appearance of these tissues is referred to as a lesion. The most serious cause for an oral mucosal lesion is oral cancer, but a great variety of infections, autoimmune conditions, and reactive processes may also create lesions your mucosa.
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, hoarseness, or ear ache.
- Difficulty in chewing or swallowing.
- Pain does not always occur with pathology, and curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause may also be at risk for oral cancer.
Dr. Jelic can often determine the cause of your condition after learning your medical history, the history of your condition, and performing a clinical examination. Many of these conditions may however, look similar to each other. When any doubt arises about the cause for a lesion, Dr. Jelic will recommend sampling a small piece of the tissue so it can be evaluated by a pathologist. The biopsy procedure is often a very simple procedure performed after the tissue is numbed with local anesthesia. Definitive treatment of the lesion will be dictated by the findings of the pathologist.
Hard Tissue Pathology
A variety of pathologic conditions may affect the bones and teeth. Tumor is the generic term for a solid tissue masses. Hard tissue tumors grow most often, within the marrow spaces of a bone. Tumors may be malignant, but facial bone tumors are most often benign.
Cysts are soft tissue sacks that expand like water balloons as they collect fluid. Some “garden variety” types of cysts such as dentigerous cysts are easily removed along with an impacted tooth. Other types of cysts such as Odontogenic Keratocysts can expand aggressively and have a high recurrence rate.
Another painful type of pathologic process that can destroy bone is osteomyelitis. Osteomyelitis is an infection within the marrow of a bone. It is often caused by infected teeth that have not been tended to.
A condition, related to osteomyelitis, is Bisphosphonate Related Osteonecrosis of the jaw. This condition is associated with bone preserving medications such as Actinal, Phosamax, Boniva and other intravenous forms of these medications. Although the pathologic process (osteonecrosis) is in the bone, the first signs of a problem often looks like an ulcer in the oral mucosa.
Your general dentist or Oral and Maxillofacial Surgeon may recommend a panoramic X-ray of your facial bones as part of your routine examination. Your doctor will do this because most hard tissue lesions will grow very slowly and not create any symptoms. They can expand to a very large size before creating any noticeable problem. The panoramic X-ray is the best tool to discover their occurrence.
Dr. Jelic will be able to narrow down the possibilities for your condition based upon the appearance on the X-ray. Frequently, Dr. Jelic will need to obtain a sample of the tissue that is creating the lesion before he can prescribe any definitive treatment for the condition.
As with most issues in life, the solution to a problem is easiest when the problem is addressed right away. You should immediately seek a professional opinion if you have developed any of the symptoms described below:
- Numbness or tingling in the lips or soft tissue.
- Teeth that do not feel solid or that feel lose.
- Jaw bone that seems to be very flexible or give a pressure sensation when biting.
- Bone that appears to be expanding or developing a lump.
- Facial swelling or asymmetry.
- Pain may or may not be present.
- Dentures that suddenly do not seem to fit.