Oral Biopsy
If you present to your dentist with an oral lesion or lump, it may be necessary to take a sample from the tissue in order to come to a diagnosis. This is known as an oral biopsy. Biopsies are a technique used widely within medicine to help diagnose conditions throughout the body, including cancers, infections and autoimmune diseases, among others. This blog will explore what an oral biopsy is, the indications for the procedure and how to prepare for it.
What is an oral biopsy?
Oral biopsies involve the removal of a small amount of oral tissue which is then taken to the lab and looked at through a microscope. By looking at the microcellular structure of this tissue, pathologists can then diagnose a myriad of conditions including, but not limited to:
Infections e.g. herpes simplex virus,
Autoimmune diseases e.g inflammatory bowel disease
Cancers e.g. squamous cell carcinoma
Oral biopsies are generally recommended when a patient has either a persistent lesion or a lesion that is unusual in appearance. It is important to keep an eye on any lesions that develop within the mouth and to consult a medical professional if you are concerned.
Not all dentists will do oral biopsies, but they will certainly be able to refer you onto someone with an interest in this area.
Types of oral biopsy
There are various oral biopsy techniques that have been extensively documented in the literature.
These include
Incisional biopsy: this is when a small portion is removed from a large lesion in the oral cavity. This is typically the method used when there is a high suspicion of malignancy. These are commonly performed using a punch biopsy technique (outlined below).
Excisional biopsy: when the entire lesion is removed from the mouth. This is used when the lesion is small and well defined, allowing it to be accurately and fully removed. These are usually performed using a scalpel to remove the lesion.
Brush biopsy: this involves scraping a brush over the sample of tissue to harvest some superficial cells for examination. This may be useful in select cases for screening and early detections of cancers, although the lack of appropriate clinical trials that support its utility remains a barrier to its proliferation.
Punch biopsy: this is often used for incisional biopsies and involves using a circular tool to take a small, cylindrical sample of tissue (a core).
The oral biopsy procedure
1. Initial consultation
The first stage is to adequately prepare you for your biopsy by having a thorough consultation. During this consultation, your dentist should ask you about your medical history and any medications you are taking. Don’t be alarmed if your dentist asks about some lifestyle factors such as smoking. Tobacco smoking has been strongly associated with oral cancer.
2. Anaesthesia
This procedure is usually done when a patient is conscious and using local anaesthetic. This is a numbing injection that is injected into and around the suspicious lesion. This will make the area numb so you cannot feel the biopsy occur. Note, if you are having a punch biopsy, there will be a loud click, like the sound of a stapler. This can be unsettling for some patients, but it should not cause any pain.
3. Tissue removal
The tissue is then removed using one of the methods outlined above. Incisional and punch biopsies are the most commonly used for diagnostic procedures.
4. Closure
If needed, the site will be closed with one or two sutures. Most cases will not require any stitches. These are usually dissolvable.
5. Sample sent to the laboratory: following the biopsy, your dentist will send your sample to the laboratory to be looked at under a microscope. Your dentist will inform you of the usual timeline for hearing your results.
Benefits
Early detection: oral biopsies can lead to earlier detection of complex oral issues including cancers. This allows appropriate care to be initiated earlier, improving your long term prognosis and improving quality of life.
Accurate diagnosis: incisional biopsies have been shown to be approximately 90% accurate in terms of reaching a diagnosis when compared to the definitive resection diagnosis for different oral lesions.
Peace of mind: there’s nothing worse than the unknown. Oral biopsies provide accurate diagnosis to help patients understand the exact nature of the suspicious lesion.
Risk
As with any oral procedure, an oral biopsy carries some risks that should be considered prior to surgery. These are very rare and almost non-existent but may include:
Infection: a biopsy may introduce bugs to sites of interest that may cause infections. Look out for swelling, pain and discharge from the biopsy site.
Pain: you should expect some pain following surgery. Any lasting pain may indicate some nerve damage but this is rare. Over the counter medications should help with easing the pain.
Bleeding: minor bleeding is expected, but more serious bleeding is very rare. Look out for this complication following surgery, and escalate to a health professional if it is heavy or not resolving.
Recovering
Looking after yourself following an oral biopsy is crucial for healing and reducing the chance of any complications. Some tips include.
Pain and swelling: you should manage thiswith over the counter pain relief and ice.
Maintain good oral hygiene: gently brushing your teeth, avoiding the biopsy site and using some warm saltwater to wash the mouth can help in the early stages.
Diet: a softer diet, and avoiding spicy / acidic foods may be useful in the short term as they may irritate the biopsy site.
Attend your follow up appointments
What can The Harley Street Implant Centre
Understanding the process of an oral biopsy is a vital part of the preparation to help ease anxiety and protect you from complications.
Dr James is a Specialty Doctor in Oral and Maxillofacial surgery, which has given him plenty of experience performing oral biopsies for the diagnosis of suspicious oral lesions. Contact us now if you have any questions about oral biopsies, what they involve or if you would like to book in for a consultation regarding an oral lesion – we would be happy to help!