Oral and Maxillofacial Pathology

Oral pathology (maxillofacial pathology or stomatognathic) refers to any disease of the oral cavity (mouth) and jaw, as well as facial muscles, orofacial skin, salivary glands, and temporomandibular joints. Oral and maxillofacial pathology may also be called:

• Mouth disease
• Oral pathology
• Dental disease
• Stomatognathic disease

The oral cavity is susceptible to disease due to its increased exposure to bacteria and germs during activities such as eating, drinking, breathing, and speaking.

Common Oral Pathology

Common oral diseases include:

• Oral cancer
• Tumors of the orofacial tissues
• Canker sores and cold sores
• Salivary gland disorders
• Bacterial, viral, and fungal infections

An oral pathological process often presents as an alteration in the appearance of the skin inside of the mouth (mucosa), which is normally a coral pink color and smooth in nature.

Other areas which can be affected by oral pathology include:

• Lips
• Gum tissue
• Tongue
• Roof of the mouth (palate)
• Face
• Neck

Signs and Symptoms of Oral Pathology

Because mouth diseases often present no pain, it is important to be aware of the signs and symptoms that may indicate a pathological process, including:

• Velvety, white patches (leukoplakia) inside the mouth
• Red patches (erythroplakia) in the mouth
• Persistent sore in the mouth that bleeds easily and will not heal
• Chewing and/or swallowing difficulty
• Chronic hoarseness or sore throat
• Thickening of an area of skin inside the oral cavity
• Lump or bump in the mouth or on the lips, face, or neck
• Change in occlusion (how teeth fit together)
• Unexplained pain, numbness, or tenderness in the orofacial area

Diagnosing Oral and Maxillofacial Pathology

Most diseases of the mouth are discovered through self-examination or during a routine dental screening. Regularly performing an oral self-exam can assist with early detection of an oral pathology.

Oral Self-exam

The Pacific Oral Surgeons recommend a monthly self-examination. An oral self-exam should be performed with a mirror and a bright light and should include:

• Removal of dental fixtures (dentures, retainers)
• Examining and palpating the front of the gums and skin inside the lips
• Sticking out the tongue to check all surfaces
• Feeling and examining the palate while head is tilted back
• Pulling out the cheeks to check the inner cheeks and back gums
• Feeling the sides of the neck and under the mandible (lower jaw) for enlarged lymph nodes or lumps

If you should discover any symptoms of oral disease that do not resolve within 2 weeks, contact your dentist for a thorough oral evaluation.

If an abnormality is identified, your dentist will refer you to an oral and maxillofacial surgeon, such as those at Pacific Oral Surgery, who will perform an extensive oral exam.

Diagnostic Tests for Oral Pathology

Your oral surgeon’s examination may include diagnostic tests such as:

• X-rays
• CT scan (On-site Cone Beam Computerized Tomography (CBCT) scanner)
• MRI
• Biopsy

In order to obtain a definitive diagnosis, your oral surgeon will perform a biopsy on the affected area. During a biopsy, a small piece of tissue is removed for microscopic evaluation. Some small lesions are removed entirely during a biopsy, while only a portion of a larger lesion is removed.

Biopsies can often be performed as an in-office procedure under local anesthesia. A pathology lab examines the biopsied tissue and provides a report to the oral surgeon for a diagnosis.

The majority of oral pathological processes are benign in nature and can be treated with medication or a relatively simple surgical procedure, however, oral cancer has been increasing for the past ten years.

Oral Cancer

The most serious oral and maxillofacial pathology is oral cancer. Oral cancer occurs when the DNA of the cells in the mouth or lips changes, or mutates, which allows cancer cells to grow and multiply. Accumulated cancer cells form a tumor which can spread, not only in the oral cavity, but to other areas of the body.

Approximately 5% of reported cancers involve the neck and head areas. The most common type of mouth cancer begins in the squamous cells inside the lips and mouth and is called squamous cell carcinoma.

Cancer can affect any area of the oral cavity including:

• Floor or roof of mouth
• Tongue
• Lips
• Gums
• Inner linings of cheeks

Causes of Oral Cancer

Chronic tobacco and alcohol use (especially together) are the most common causes of the development of oral cancer. Recently, however, research has shown that exposure to the human papilloma virus (HPV) is becoming a significant factor in oral cancer, as well.

Other contributors to oral cancer may include:

• Chronic sunlight exposure (in lip cancer development)
• Genetics/family history
• Poor oral hygiene
• Oral irritation, such as from rough teeth surfaces or poorly fitted dentures
• Weakened immune system
• Poor nutrition
• Smoking marijuana

Surgical Treatment for Oral Cancer

Early detection is extremely important in treating oral cancer. Suspicious sores or lumps should be examined professionally if they persist over 2 weeks. When discovered in the early stages, oral cancer is typically treated with either radiation or surgery alone. Later stages of oral cancers are usually treated with a combination of methods.

During primary tumor surgery, the tumor is removed, as well as a portion of healthy surrounding tissue (the margin), to ensure that no cancer remains. The goal of oral surgery for cancer is the complete removal of the cancerous tumor while leaving negative margins (no cancer in the surrounding tissue).

The type and complexity of oral surgery performed will depend on the location and stage of cancer present.

Other common surgeries to remove oral cancer include:

• Maxillectomy: Removal of part or all of the bony roof of the mouth (hard palate)
• Mandibulectomy: Partial or complete jawbone removal
• Laryngectomy: Partial or entire removal of the larynx
• Transoral laser microsurgery (TLM): Minimally invasive surgery in which a laser connected to an endoscope is used to remove a tumor
• Transoral robotic surgery (TORS): Minimally invasive endoscopic surgery in which robotic instruments are used to remove a tumor
• Micrographic surgery: Technique involving the removal of one layer of skin at a time to microscopically examine it (often used in lip cancer treatment)

Additional surgical procedures that may be recommended include:

• Neck dissection: Removal of cancerous lymph nodes that have spread to the neck
• Mouth reconstruction surgery: Grafts of muscles, bone, or skin may be necessary to reconstruct the oral cavity

Preventing Oral Cancer

Maintaining a healthy lifestyle is key to preventing oral cancer. Take an active role in your oral health by following these steps:

• Do not use tobacco products or marijuana
• Limit sun exposure and use protective sunblock when in the sun
• Eat a healthy, well-balanced diet rich in Vitamin A
• Limit alcohol intake
• Conduct an oral self-examination every month
• Visit your dentist regularly for oral cancer screenings

If you have been diagnosed with oral cancer, the surgeons of Pacific Oral Surgery will work as part of a multispecialty team to give you the best surgical treatment available. If your dentist suspects that you have an oral pathology, contact our office for an evaluation by submitting an online appointment request or calling one of our three Pacific Oral Surgery offices located in Ventura, Thousand Oaks and Simi Valley.