3d image of teeth being cleaned with a pick

Understanding Oral Pathology

Oral pathology refers to the diseases or abnormalities occurring within the mouth. The two main categories involving lesions or abnormalities caused by disease are hard tissue, referring to the bone, and soft tissue, referring to the gums, cheeks, lips, tongue, and palate. Lesions can be either benign or malignant.

  • Soft Tissue Pathology
  • Hard Tissue Pathology
  • Treatment of BRONJ

Soft Tissue Pathology

Pathology of the soft tissues in the mouth may be either benign or, in rare cases, malignant in nature.

Benign Lesions Range From:

  • Local irritations
  • Traumatic ulcers
  • Areas of thickened tissue called hyperplasia
  • Areas of autoimmune inflammation

Malignant Lesions

The prominent malignant, or cancerous, lesion in the oral cavity is squamous cell carcinoma. Squamous cell carcinoma is most common in people who smoke and consume alcohol.

Squamous cell carcinoma can have many different appearances:

  • Red in color
  • White in color
  • Mixed red and white in color
  • Can look like an ulcer

Squamous cell carcinoma may occur on the tongue, the cheeks, the lips, the palate, or the gums.

Biopsy of a Soft Tissue Lesion

The appearance of a soft tissue lesion can give a great deal of information about its nature and diagnosis, but a definitive diagnosis cannot be established without performing a biopsy. A biopsy will allow the tissue to be sent to the lab and be examined under a microscope and diagnosed conclusively, which then allows for decisions about proper treatment going forward, if any is required.

Hard Tissue Pathology

Lesions of the hard tissues of the oral cavity often occur in the bone and can be varied in nature. For the most part, malignant or cancerous lesions are very rare. The most common cancerous lesion of the jaws is a metastatic cancer from other parts of the body, such as the lungs, prostate, or breast. Other lesions of the jaw include cysts or benign tumors. These lesions typically grow slowly.

Symptoms of a Cyst or Benign Tumor:

  • Areas of swelling
  • Mild pain
  • Change in bite

Treatment of Medication-Related Osteonecrosis of the Jaws (MRONJ)

Over the past 2 decades, a class of drugs has been used more commonly in the treatment of osteoporosis and cancer-related bone disease. If you have taken any of these medications, you may be experiencing certain side effects that contribute to bone decay in the mouth and should consider treatment.

Common medications associated with MRONJ include:

  • Pamidronate (Aredia)
  • Alendronate (Fosamax)
  • Ibandronate (Boniva)
  • Risedronate (Actonel)
  • Zoledronate (Zometa or Reclast)
  • Denosumab (Prolia or Xgeva)

One serious side effect of these medications is poor healing of bone and poor resistance to infection. This can ultimately lead to areas of dead bone, which slowly may progress until addressed. Treatment of MRONJ will vary greatly depending on the severity, and may be as simple as observation or as involved as surgery. Dr. Tomlinson will discuss all treatment options during the consultation appointment.


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