Soft and Hard Tissue Biopsy
When a growth or sore of questionable nature is detected in the mouth, a biopsy is often required. A biopsy is a diagnostic test involving the removal of a tissue sample for examination under a microscope to ascertain whether a malignancy or other disease process is present.
Reasons for Oral Biopsies
There are some oral lesions which can be precisely diagnosed through physical examination and patient history. When there is a question concerning the origin of an abnormal lesion, however, an oral biopsy may be required.
An oral biopsy, performed to identify abnormal cells, is usually recommended unless the suspect lesion has been present and remained unchanged for five years or longer. During an oral biopsy, tissue from the mucosa is removed and examined microscopically.
The aim of the oral biopsy is to define a lesion on the basis of the possible pathology of its cells, known as histopathology. This is done to establish a prognosis and to outline a specific course of treatment. Oral biopsies may be required when an unexplained pigmented oral lesion has recently appeared or suddenly changed its appearance. Usually, the dentist or oral surgeon will wait for two weeks after the first appearance of a new or altered lesion to perform a biopsy since abnormalities resulting from infection, inflammation or local trauma may resolve during this period of time.
Types of Oral Biopsies
In certain unusual circumstances, oral biopsies may be performed as needle biopsies, punch biopsies, forceps biopsies or electrocautery biopsies, but these types are not generally found to produce satisfactory specimens for microscopic examination. Most oral biopsies are performed with a small scalpel in one of two ways. These include:
Incisional oral biopsy
An incisional biopsy is performed to remove part of a larger mass to be sampled and screened. This will be used to determine if the mass is malignant or benign.
Excisional oral biopsy
An excisional biopsy involves the removal of the entire lump or suspicious growth rather than only a part of it. Excisional biopsies are usually performed when the lump is small. If a lesion interferes with function or is particularly unattractive, it may be excised even if it is found to be benign.
Contraindications for Oral Biopsies
Patients with underlying osteonecrosis, the death of bone tissue in the jaw, are not good candidates for oral biopsies, since any manipulation of the affected site may exacerbate their condition. Osteonecrosis may be the result of previous radiation treatments or the use of certain medications. Since even skilled professionals may have trouble distinguishing between benign and malignant oral changes, the decision about whether to do an oral biopsy should be made after careful doctor-patient consultation.