About Oral & Maxillofacial Pathology
Oral & Maxillofacial Pathology is defined as a specialty of dentistry and pathology that deals with diagnosing and treating tumors, lesions, cysts, or other abnormal growths that develop in the soft tissue or the bone of the mouth and face. It is a science that investigates the causes, processes and effects of these diseases. The practice of oral and maxillofacial pathology includes diagnosis of diseases using clinical, radiographic, microscopic, biochemical or other examinations, and management of patients. Dental specialists send surgical pathology specimens (biopsies) of the oral cavity, head, and neck for microscopic analysis and diagnosis. In this section we briefly discuss topics like Oral Biopsies, Hyperplastic Lesions, Oral Precancers, Salivary Glands, and Dry Mouth (Xerostomia).
Oral Biopsy
The inside of a normal healthy mouth is lined with special type of skin (mucosa) which in appearance is smooth and coral pink in color. If you notice any deviation or alteration could well be a pathological condition needing immediate attention. The cause of utmost concern is when it is an oral cancer, particularly for those who smoke and consume alcohol regularly. The self check or consult may include chronic sore throat or hoarseness; difficulty in chewing or swallowing; reddish patches (erythroplasia); whitish patches (leukoplakia), reddish-whitish patches (erythroleukoplakia); a lump or thickening of the mucosa; sudden onset of numbness or tingling sensation to lip, chin, tongue or teeth; ulcers that don't disappear.
Your dentist or oral and maxillofacial surgeon may need to take a biopsy, or a small sample, of the growth in order to determine whether or not it is cancerous. Treatment may include removing lesions that are precancerous or cancerous. It is important these are caught sufficiently early. To treat lesions, cysts and tumors an excision is made in the pathological region and a small area of the surrounding tissue just to make sure that all abnormal tissue is gone. Dental specialists refer Clinical Oral Pathology patients for evaluation and treatment of such conditions as burning mouth/tongue; oral leukoplakia; oral ulceration; oral fungal infections, autoimmune diseases (lichen planus, pemphigoid, pemphigus, etc.); salivary gland disease; hyperplastic lesions; orofacial pain; dry mouth.
Burning Mouth / Burning Tongue Syndrome
Often patients complain of abnormal burning sensation in the front parts of the mouth, typically affecting the inner surfaces of the lips, the roof of the mouth and the sides and tip of the tongue. For some patients only tongue will be affected with a feeling of altered taste and sticky or dryness of mouth. The lining of the mouth however may clinically appear normal. The pain ranges from moderate to severe, while for many it is totally absent. Pending an early dental consult, high fluid intake and oral supplementation helps.
Candidiasis (Oral thrush)
Candidiasis (Oral Thrush) is not as aggressive a problem as many others, as it does not invade the living parts of the body. It is an infection of the most superficial part of the lining of the mouth that is caused by the yeast-like fungal organism, Candida albicans. Oral Candidiasis takes the form of a superficial, curdy, and gray to white membrane that can be readily scraped off. Only more severe oral infections may produce mucosal ulceration and a correspondingly greater inflammatory reaction. Besides identified causes, anti fungal therapy is advised. Most dentists and physicians stress the importance of continuing antifungal therapy at least 2 weeks following disappearance of signs and symptoms of oral lesions.
Cicatricial Pemphigoid
Cicatricial Pemphigoid is a chronic condition that mostly affects the mucous membranes. The relatively uncommon blistering disease may also spread affecting outer surface of the eyes and the inner surface of the eyelids (the conjunctiva), the nasal cavity, throat, esophagus and vagina. Cancers are not exactly foreign, inasmuch as they arise from our own tissues, yet it is widely assumed that the immune system actively tries to find and neutralize cancers as they arise. Our immune system is an army with one mission, to seek out and destroy foreign elements, be they viruses, bacteria, fungal spores or even inanimate objects autoimmune diseases are sometimes treated with potent anti-inflammatory drugs -- corticosteroids, such as prednisone (Deltasone) or methylprednisolone (Medrol) -- or with cancer chemotherapy drugs such as methotrexate (Rheumatrex).
Geographic Tongue
Geographic Tongue is relatively a harmless condition, in which reddened areas on the top and sides of the tongue can be seen. These red areas usually have a slightly white or yellow-white, raised line around their edges. It migrates from one area to another or repeats itself in a different area or areas after a few more days, weeks or months. Most patients will experience this condition as a mild nuisance or irritation. Infrequently, powerful topical anti-inflammatory drugs (cortisone-like drugs) may have to be prescribed to help control the discomfort for those few patients who are very bothered by the problem. Geographic tongue is not known to have transformed to cancer.
Hairy-Coated Tongue
Hairy-Coated Tongue is more an irritating problem than a potentially harmful one. It mostly affects adults, and it can affect men or women. Often we take hot drinks or rough foods (tortilla chips, etc.) due to which the top surface area of the tongue is typically subjected to a lot of irritation. Our tongue produces a layer of protective dead cells called “keratin”. Sometimes this balance is upset, however, and the condition called “coated tongue” results. The accumulation of keratin on the “taste buds” of the tongue gives the tongue a kind of “hairy” appearance. The improved oral hygiene and using a tongue scraper helps remove the dead keratinized cells, normally requiring no other major treatment.
Leukoplakia
In clinical terms Leukoplakia is described as certain white patches in the mouth. There may different types of white patches present in the mouth, and not all are leukoplakia. But the patches that cannot be rubbed off and also cannot be diagnosed as any other condition may be leukoplakia. The condition should be addressed as early as possible so that over time the chances of these white patches transforming to oral cancer are reduced/removed. Mostly older men and women using tobacco are affected. After noting your medical history, the oral pathologist most likely may recommend oral biopsy. For those leukoplakias diagnosed as “moderate” or “severe”, complete removal of the white patch is usually recommended in order to prevent the development of oral cancer. While most cases of leukoplakia are cured once they are removed, it has been well documented that about one in three lesions will grow back. If the leukoplakia should recur, repeat biopsy is generally advisable.
Lichen Planus
Lichen Planus is a benign condition, not cancer, affects either the skin or the lining of the mouth, and some times both. The real cause of lichen planus is not conclusively known; what is known to cause it is an infection, like bacteria, virus or fungus, or certain foods, smoking, etc. In this condition our armies of immune cells instead of attacking bacteria or viruses, get confused and start attacking the skin or the lining of the mouth. The two main forms of lichen planus (1) Reticular, non-hurting in lace-like pattern is symptomatic affecting inside of cheeks, gums, or top of tongue; (2) Erosive, are smaller and develop in same area but are painful in contact with salt, beverages, and citric juices. Controlled use of powerful topical anti-inflammatory drugs called Corticosteroids helps.
Recurrent Aphthous Ulcerations (“Canker Sores”)
Recurrent Aphthous Ulcerations are commonly known as Canker Sores. The condition affects lining tissues of the mouth, and hardly ever on front part of the roof of the mouth (hard palate). There develop 1-5 very painful aphthous ulcerations (sores), and frequency of attacks can be quite variable, ranging from as often as once per month up to as rare as once every few years. Recurrent aphthous ulcerations are not a contagious disease; not related to any viral, bacterial or fungal infection; are a type of unusual allergic reaction. These are diagnosed on the basis of appearance and location, as biopsies, blood tests, cultures are not helpful. The variations are (1) Major Aphthous Ulcerations are larger in shape; (2) Herpetiform Ulcerations are smaller in size large in numbers like herpes; (3) Behcet’s syndrome is when mouth, eyes and genital are some times affected at the same time. Medications that tend to suppress the immune reaction help.
Salivary Glands
There are major and minor salivary glands in and around your mouth and throat, defined as parotid, submandibular, and sublingual glands. The function of salivary glands is to produce the saliva that keeps your mouth moistened, initiate digestion, and help protect dental decay. Since dehydration is a risk factor for salivary gland disease, it is important to drink lots of liquids daily. The problems that develop into disease in the salivary glands start with the obstruction to the flow most commonly occurring in the parotid and submandibular glands, usually because stones have formed. Symptoms typically occur when eating, leading to swelling, pain, infection, and if untreated may become abscessed. Primary benign and malignant salivary gland tumors usually show up as painless enlargements of these glands. Malignant tumors of the major salivary glands can grow quickly, may be painful, and can cause loss of movement of part or all of the affected side of the face. These symptoms should be immediately investigated. The diagnostics may include dental x-rays, a CT scan or an MRI or some times a Sialogram. A lip biopsy of minor salivary glands may be needed to identify certain autoimmune diseases. Salivary gland diseases are due to many different causes. These diseases are treated both medically and surgically. |
