Oral and maxillofacial pathology

Source: Wikipedia, the free encyclopedia.
"Maxillofacial disorder" redirects here. For the surgery, see
Maxillofacial surgery. For certain abnormalities of the face and/or cranium, see Craniofacial abnormality
.
Oral and maxillofacial pathology
Other namesOral pathology, stomatognathic disease, dental disease, mouth disease
SpecialtyDentistry

Oral and maxillofacial pathology refers to the diseases of the mouth ("oral cavity" or "stoma"), jaws ("maxillae" or "gnath") and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin (the skin around the mouth).[1][2] The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.[3]

The specialty oral and maxillofacial pathology is concerned with diagnosis and study of the causes and effects of diseases affecting the oral and maxillofacial region. It is sometimes considered to be a specialty of

endocrine pathologists
.

Diagnosis

The key to any diagnosis is thorough medical, dental, social and psychological history as well as assessing certain lifestyle risk factors that may be involved in disease processes. This is followed by a thorough clinical investigation including extra-oral and intra-oral hard and soft tissues.[5]

It is sometimes the case that a diagnosis and treatment regime are possible to determine from history and examination, however it is good practice to compile a list of differential diagnoses. Differential diagnosis allows for decisions on what further investigations are needed in each case.[5]

There are many types of investigations in diagnosis of oral and maxillofacial diseases, including screening tests, imaging (radiographs, CBCT, CT, MRI, ultrasound) and histopathology (biopsy).[5]

Biopsy

A biopsy is indicated when the patient's clinical presentation, past history or imaging studies do not allow a definitive diagnosis. A biopsy is a surgical procedure that involves the removal of a piece of tissue sample from the living organism for the purpose of microscopic examination. In most cases, biopsies are carried out under local anaesthesia. Some biopsies are carried out endoscopically, others under image guidance, for instance ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) in the radiology suite. Examples of the most common tissues examined by means of a biopsy include oral and sinus mucosa, bone, soft tissue, skin and lymph nodes.[6]

Types of biopsies typically used for diagnosing oral and maxillofacial pathology are:

Excisional biopsy: A small lesion is totally excised. This method is preferred if the lesions are approximately 1 cm or less in diameter, clinically and seemingly benign and surgically accessible. Large lesions which are more diffused and dispersed in nature or those which are seemed to be more clinically malignant are not conducive to total removal.[7]

Incisional biopsy: A small portion of the tissue is removed from an abnormal-looking area for examination. This method is useful in dealing with large lesions. If the abnormal region is easily accessed, the sample may be taken at the doctor's office. If the tumour is deeper inside the mouth or throat, the biopsy may need to be performed in an operating room. General anaesthesia is administered to eliminate any pain.[7]

Exfoliative cytology: A suspected area is gently scraped to collect a sample of cells for examination. These cells are placed on a glass slide and stained with dye, so that they can be viewed under a microscope. If any cells appear abnormal, a deeper biopsy will be performed.[7]

Diseases

Oral and maxillofacial pathology can involve many different types of tissues of the head. Different disease processes affect different tissues within this region with various outcomes.  A great many diseases involve the mouth, jaws and orofacial skin. The following list is a general outline of pathologies that can affect oral and maxillofacial region; some are more common than others. This list is by no means exhaustive.

Congenital

Cleft lip and palate

Cleft lip and palate is one of the most common occurring multi-factorial congenital disorder occurring in 1 in 500–1000 live births in several forms.[8][9][10] The most common form is combined cleft lip and palate and it accounts for approximately 50% of cases, whereas isolated cleft lip concerns 20% of the patients.[11]

People with cleft lip and palate malformation tend to be less social and report lower self-esteem, anxiety and depression related to their facial malformation.[12][13] One of the major goals in the treatment of patients with cleft is to enhance social acceptance by surgical reconstruction.

A cleft lip is an opening of the upper lip, mainly due to the failure of fusion of the medial nasal processes with the palatal processes; a cleft palate is the opening of the soft and hard palate in the mouth, which is due to the failure of the palatal shelves to fuse together.[10]

The palate's main function is to demarcate the nasal and oral cavity, without which the patient will have problems with swallowing, eating and speech, thus affecting the quality of life and in some cases certain functions.[10]

Some examples include food going up into the nasal cavity during swallowing as the soft palate is not present to close the cavity during the process. Speech is also affected as the nasal cavity is a source of resonance during speech and failure to manipulate spaces in the cavities will result in the lack of ability to produce certain consonants in audible language.[10]

Macroglossia

Macroglossia is a rare condition, categorised by tongue enlargement which will eventually create a crenated border in relation to the embrasures between the teeth.[14]

Hereditary causes include vascular malformations, Down syndrome, Beckwith–Wiedemann syndrome, Duchenne muscular dystrophy, and Neurofibromatosis type I.[14]

Acquired causes include

lingual thyroid,[5] myxedema,[14] and amyloidosis.[14]

Consequences may include noisy breaths – airway obstruction in severe cases, drooling, difficulty eating, lisping speech, open bite, and protruding tongue, which may ulcerate and undergo necrosis.[14]

For mild cases, surgical treatment is not mandatory but if speech is affected, speech therapy may be useful. Reduction glossectomy may be required for severe cases.[14]

Ankyloglossia

lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth.[16]

Stafne defect

mandible, most commonly located on the lingual surface (the side nearest the tongue).[citation needed
]

Torus palatinus

Torus palatinus is a bony protrusion on the palate, usually present on the midline of the hard palate.[citation needed]

Torus mandibularis

Torus mandibularis is a bony growth in the mandible along the surface nearest to the tongue. Mandibular tori usually are present near the premolars and above the location on the mandible of the mylohyoid muscle attachment.[17]

Eagle syndrome

Eagle syndrome is a condition where there is an abnormal ossification of the stylohyoid ligament. This leads to an increase in the thickness and the length of the stylohyoid process and the ligament. Pain is felt due to the pressure applied to the internal jugular vein. Eagle syndrome occurs due to elongation of the styloid process or calcification of the stylohyoid ligament. However, the cause of the elongation has not been known clearly. It could occur spontaneously or could arise since birth. Usually normal stylohyoid process is 2.5–3 cm in length, if the length is longer than 3 cm, it is classified as an elongated stylohyoid process.[18]

Acquired

Infective

X-ray of advanced bone loss due to periodontitis
Bacterial
Viral
  • herpes labialis). HSV infections tend to recur periodically. Although many people get infected with the virus, only 10% actually develop the sores. The sores may last anywhere from 3–10 days and are very infectious. Some people have recurrences either in the same location or at a nearby site. Unless the individual has an impaired immune system, e.g., owing to HIV or cancer-related immune suppression,[22] recurrent infections tend to be mild in nature and may be brought on by stress, sun, menstrual periods, trauma or physical stress.[23]
  • inflammation of the brain, pancreatitis, testicular swelling or hearing loss.[24]
Fungal
Pseudomembranous candidiasis of the posterior mouth and oropharynx
  • dentures and tongue piercing. The typical signs are a white patch that may be associated with burning, soreness, irritation or a white cheesy-like appearance. Once the diagnosis is made, candida can be treated with a variety of anti fungal drugs.[25]
Traumatic
  • Chemical, thermal, mechanical or electrical trauma to the oral soft tissues can cause traumatic
    oral ulceration
    .
Autoimmune

dry mouth (xerostomia). Based on a meta-analysis, the prevalence of pSS worldwide is estimated to 0.06%, with 90% of the patients being female.[26] In secondary Sjögren syndrome (sSS), individuals have a dry mouth, dry eyes and a connective tissue disorder such as rheumatoid arthritis (prevalence 7% in the UK), systemic lupus erythematosus (prevalence 6.5%–19%) and systemic sclerosis (prevalence 14%–20.5%).[27]
Additional features and symptoms include:

  • Erythema and lobulation of the tongue
  • Oral discomfort
  • Difficulty in swallowing and talking
  • Altered taste
  • Poor retention of dentures (if worn)
  • Oral fungal and bacterial infections
  • Salivary glands swelling
  • Dryness of skin; nose; throat; vagina
  • Peripheral neuropathies
  • Pulmonary; thyroid; and renal disorders;
  • Arthralgias and myalgias;

Tests used to diagnose Sjögren syndrome include:

There is no cure for Sjögren syndrome; however, there are treatments used to help with the associated symptoms.

  • Eye care: artificial tears, moisture chamber spectacles, punctal plugs, pilocarpine medication
  • Mouth care: increase oral intake, practice good oral hygiene, use sugar free gum (to increase saliva flow), regular use of mouth rinses, pilocarpine medication, reduce alcohol intake and smoking cessation. Saliva substitutes are also available as a spray, gel, gum or in the form of a medicated sweet
  • Dry skin: creams, moisturising soaps
  • Vaginal dryness: lubricant, oestrogen creams, hormonal replacement therapy
  • Muscle and joint pains: Non-steroidal anti-inflammatory drugs

Complications of Sjögren syndrome include ulcers that can develop on the surface of the eyes if the dryness is not treated. These ulcers can then cause more worrying issues such as loss of eyesight and life-long damage. Individuals with Sjögren syndrome have a slightly increased risk of developing non-Hodgkin lymphoma, a type of cancer. Other conditions such as peripheral neuropathy, Raynaud's phenomenon, kidney problems, underactive thyroid gland and irritable bowel syndrome have been linked to Sjögren syndrome.[28]

Inflammatory

Neoplastic

Oral cancer on the tongue.

Environmental

Unknown

There are many oral and maxillofacial pathologies which are not fully understood.

  • Burning mouth syndrome (BMS) is a disorder where there is a burning sensation in the mouth that has no identifiable medical or dental cause. The disorder can affect anyone but tends to occur most often in middle-aged women. BMS has been hypothesized to be linked to a variety of factors such as the menopause, dry mouth (xerostomia) and allergies. BMS usually lasts for several years before disappearing for unknown reasons. Other features of this disorder include anxiety, depression and social isolation. There is no cure for this disorder and treatment includes use of hydrating agents, pain medications, vitamin supplements or the usage of antidepressants.[30]
2 minor aphthae on the lower labial mucosa
  • Aphthous stomatitis is a condition where ulcers (canker sores) appear on the inside of the mouth, lips and on tongue. Most small canker sores disappear within 10–14 days. Canker sores are most common in young and middle aged individuals. Sometimes individuals with allergies are more prone to these sores. Besides an awkward sensation, these sores can also cause pain or tingling or a burning sensation. Unlike herpes sores, canker sores are always found inside the mouth and are usually less painful.[citation needed] Good oral hygiene helps but topical corticosteroids may be necessary.[31]
Geographic tongue
  • floor of the mouth.[32]

Specialty

Occupation
NamesOral and Maxillofacial Pathologist, Oral Pathologist
Occupation type
Specialty
Activity sectors
Pathology, Dentistry, Medicine
Specialtygastroenterology
Description
Education required
Varies. Typically dental degree followed by specialist training

Oral and maxillofacial pathology, previously termed oral pathology, is a speciality involved with the diagnosis and study of the causes and effects of diseases affecting the oral and maxillofacial regions (i.e. the mouth, the jaws and the face). It can be considered a speciality of dentistry and pathology.[4] Oral pathology is a closely allied speciality with oral and maxillofacial surgery and oral medicine.

The clinical evaluation and diagnosis of oral mucosal diseases are in the scope of oral and maxillofacial pathology specialists and oral medicine practitioners,[33] both disciplines of dentistry.

When a

pathologist. The American Dental Association uses the term oral and maxillofacial pathology, and describes it as "the specialty of dentistry and pathology which deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes and effects of these diseases."[34]

In some parts of the world, oral and maxillofacial pathologists take on responsibilities in

forensic odontology
.

Geographic variation

United Kingdom

There are approximately 30 consultant oral and maxillofacial pathologists in the UK. A dental degree is mandatory, but a medical degree is not. The shortest pathway to becoming an oral pathologist in the UK is completion of two years' general professional training and then five years in a diagnostic histopathology training course. After passing the required

PhD
either prior to or during training. Generally, oral and maxillofacial pathologists in the UK are employed by dental or medical schools and undertake their clinical work at university hospital departments.

New Zealand

There are five practising oral pathologists in New Zealand (as of May 2013[update]).[36] Oral pathologists in New Zealand also take part in forensic evaluations.[36]

See also

References

  1. ^ "gnath(o)-". TheFreeDictionary.com.
  2. ^ "ICD-10".
  3. ^ Mouth Disease Information Archived 2010-02-06 at the Wayback Machine Retrieved on 2010-02-01
  4. ^
    ISBN 978-0721690032
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  5. ^
    OCLC 960030340.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: multiple names: authors list (link
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    OCLC 834142726.{{cite book}}: CS1 maint: others (link
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  11. ^ Young G. Cleft Lip and Palate. Available at http://www2.utmb.edu/otoref/Grnds/Cleft-lip-palate-9801.htm[permanent dead link].
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    OCLC 908336985.{{cite book}}: CS1 maint: location missing publisher (link
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  19. ^ "Periodontal (Gum) Disease: Causes, Symptoms, and Treatments". National Institute of Dental and Craniofacial Research. Retrieved 2013-12-27.
  20. ^ "Gingivitis". Emedicine. Retrieved 2013-12-25.
  21. ^
    OCLC 61756542
    .
  22. S2CID 2969472
    .
  23. ^ Herpes Guide: How do I know if I have herpes Canadian Herpes Information portal. Retrieved on 2010-02-01
  24. ^ What are Mumps Archived 2010-02-05 at the Wayback Machine Ministry of health and long term care portal. Retrieved on 2010-02-01
  25. ^ "Women's Oral Health and Overall". Archived from the original on 2009-12-03. Retrieved 2010-02-02.
  26. S2CID 23211726
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  27. PMID 25114590
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  28. S2CID 11132886
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  30. ^ Burning Mouth Syndrome Archived 2010-12-03 at the Wayback Machine American Academy of Family Physicians. Retrieved on 2010-02-01
  31. ^ Diseases of the Digestive System The oral cavity FAQ's Health Portal. Retrieved on 2010-02-01
  32. PMID 21763590
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  33. PMID 21883487
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  34. ^ "ADA.org: Dentistry Definitions". Archived from the original on 2009-02-28. Retrieved 2010-02-02.
  35. ^ "The British Society of Oral & Maxillofacial Pathologists". Archived from the original on 10 December 2013. Retrieved 25 April 2013.
  36. ^ a b "Specialisation". New Zealand Dental Association. Archived from the original on 5 March 2016. Retrieved 10 September 2013.

Further reading

External links

Wikiversity has learning resources about Oral pathology
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