The oral cavity is not only important for the presence of teeth. There are any important anatomical structures that allow correct function of many body systems, from the digestive tract to the postural balance. The mouth includes different organs such as the tongue, tonsils, glands and gingiva that determine different mouth functions. Unfortunately, these tissues and organs are not free of diseases and pathologies. The oral pathologist is the specialist who is trained to recognize and identify these diseases associated to the mouth. Depending on the diagnosis and location of the lesion, the oral pathologist can orchestrate the referral to the other specialists for treatment.

In fact, oral pathologies are topic of interest for maxillofacial surgeons, periodontists and endodontist since they pertain to their field. What makes oral pathology a challenging topic is the multitude of lesions and tissue alterations that often mimic and superimpose each other. For this reason, the diagnosis part is not only based on visual recognition of patterns, color and shapes of lesions but it often requires microscopical analysis. In such cases, the oral pathologist recommends a partial or total removal of the lesion to be analyzed by a lab under microscopes.

This microscopical analysis is important for the recognition and classification of the lesion itself as well as for an understanding of its extension and which tissues they involve. The treatment of these lesion can be mandatory or optional. In fact, some lesions are identified when they are already transformed in malign entities (cancers). They do not have to be very large to be dangerous and spread around. For this reason, dentists and specialist are very important to identify alterations as early as possible. In terms of optional treatment, some other lesions are completely benign and they do not alter mouth function or health whatsoever (i.e. amalgam tattoos, condensing osteitis). These can be treated if they alter esthetics or result in uncomfortable structures that limit function. But what causes these lesions? First, these lesions or alterations can be congenital (bony torus, tongue size alterations) or acquired (viral, bacterial, traumatic, autoimmune and so on). Other factors can help their manifestation such has smoking, stress and diet. Based on these causes, the treatment can differ. Some require topical medicaments, some systemic approach and other surgical removal. Depending on the size, extension and location of the lesion, the removal can be simple or complex.

The importance of regular visits to the dentists not only concerns teeth health but the oral cavity too. The so called “oral cancer screenings” are an example of a routine mouth inspection, to identify presence of undesired tissue lesions. Patient could also be of a help if they recognized the presence of unnatural or new tissue appearance and report them their dentist or surgeons. Periodontists are very involved in this processes. Due to their training, they can remove, collect and improve multiple situation that require fine surgical skills.

-By Lorenzo Mordini DDS, MS

Fig.3 Microscopic image of a piece of tissue removed. Layers of cells are present. the pathologist will recognize abnormal cells of tissue layers and make a correct diagnosis.

 

Fig. 1. Gingival lesion affecting upper molar. Notice the change in color and pattern. The lesion was completely removed with a surgical excision.

 

Fig. 2. Tissue proliferation due to presence of a foreign body in the gingiva. Lesion was removed and area healed completely.

 

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