When a patient visits the dentist, he or she will perform a clinical extra-oral and intraoral soft tissue examination as part of the initial assessment. Part of this examination involves looking for any intraoral lesions. If a lesion is discovered, depending on the location, radiographs may be taken to assess the underlying bone. When an oral lesion is identified which appears suspicious or of concern to the dentist, he/she may recommend performing a soft tissue biopsy. This will allow the dentist to submit the tissues to a Pathologist, who will then evaluate the lesion under a microscope in order to identify and diagnose it. If the lesion has extended into the bone, the dentist may refer the patient to a specialist for management.
There are two types of soft tissue biopsies which can be performed by the clinician, depending on the size of the lesion. If the lesion measures 1 cm or more it would generally require a definitive diagnosis before further treatment can be planned and performed. These biopsies are generally done by a specialist. Smaller lesions measuring less than 1 cm, and which are located in easily accessible regions of the mouth can be performed by a general dentist. In both situations, the biopsy is generally performed in an outpatient setting under local anesthetic. For those patients who are extremely apprehensive, oral and intravenous sedation can be utilized in conjunction with local anesthetic. It is important to discuss these options with the dentist.
Prior to performing the procedure, the dentist should provide the patient with some possibilities of what the lesion may represent. In some instances this may not be possible; however the dentist must discuss the risks versus benefits of performing the biopsy to gain a definitive diagnosis.
In general, once the region to be biopsied is appropriately anesthetized or “frozen”, an elliptical incision is made approximately 1 mm away from the outer borders of the lesion and carried approximately 1 to 2 mm below the deepest margin of the lesion. By performing an elliptical shaped incision, the dentist is able to close the surgical wound in a straight line. This will allow for improved healing with minimal scarring. Once the lesion is freed or cut away from the oral soft tissues, it is immediately placed in to a jar containing a sterile fixation solution. This allows the dentist to transport the lesion to the pathologist for final evaluation and diagnosis.
The patient is often asked to apply firm pressure to the surgical site with sterile, 2 x 2, gauze or sterile sponge after the procedure in order to assist with hemostasis or clot formation. The patient should be provided with a packet of gauze to change out every 20 to 30 minutes until the bleeding subsides. This generally requires 5 to 10 changes. The gauze must not be kept in the mouth overnight.
The patient is sometimes placed on oral antibiotic therapy following the surgical procedure for a period of 7 to 10 days. Additionally, the dentist may provide the patient with a prescription for pain medication and a medicated mouth rinse to use during the first week of healing.
The patient should be scheduled for a follow-up with the dentist in 7 to 10 days for re-assessment of the surgical wound and for discussion of the diagnosis. Based on the diagnosis, further intervention, including referral to a specialist may be required. If the diagnosis reveals complete excision of the lesion with no need for further treatment, the patient should be seen for routine follow-up during the healing period and the site should be evaluated on recall visits to the dentist’s office.
A copy of the biopsy report may be provided to the patient. Upon request by the patient, a copy of the report may also be sent to the patient’s physician and other health care professionals whom the patient is seeing routinely.
Simple intra-oral soft tissue biopsy is a common surgical procedure routinely performed by both general dental practitioners and dental specialists as a method of diagnosis and treatment of lesions in the oral cavity.