Oral Pathology: A Clinical Review

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Introduction
The practice of dentistry is an application of art and science. In everyday practice, the dental practitioner reviews many cases of suspected pathology, and while some case presentations are very common, others are not common. This course is a refresher course of fairly common oral pathology conditions. A very strong background in clinical dental practice is assumed for this course. The course is most suitable for dentists and dental hygienists who want a good review with clinical case presentations and radiographs to support the text. However, the course would be a useful summary and review for all members of the dental team who want to familiarize themselves with an overview oral pathology in clinical practice. This course is ADA CERP approved for 4 hours of continuing education credit, and fulfills credit hours toward license renewal. Individuals must check with their state licensing boards for exact requirements for dental license renewal.

Statistics on Worldwide Occurrence
Citing the Oral Cancer Foundation:

Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ) BRONJ
Bisphosphonates are a class of drugs that prevent the loss of bone mass. High-potency intravenous bisphosphonates have been shown to modify the progression of malignant bone disease in several forms of cancer, especially breast and frequently prostate cancer. Oral bisphosphonates are used to treat osteoporosis, osteitis deformans (Paget's disease of the bone) and other conditions that lead to bone fragility.

Stage 1
Stage 1 -is characterized by exposed bone, that shows no indication of disease or inflammation of the soft tissue around the bone.

Stage 2
Stage 2 -is distinguished by painful areas of exposed bone accompanied by soft tissue or bone inflammation or infection.

Stage 3
Stage 3 -is the most advanced stage of BRONJ. One of the most significant features is a fracture of bone that has been weakened by the disease. In addition, there is an extensive amount of exposed bone, soft-tissue inflammation and infection.
(American Academy of Oral and Maxillofacial Surgeons, 2013) Panoramic radiograph revealing a segment of detached necrotic bone in the lower left jaw of a patient receiving oral bisphosphonates for osteoporosis.

Oral Cancer and Technology in Research
In 2016, mechanical engineers at the University of Washington, have constructed a pen-size cancer cell detecting microscope, which is a huge breakthrough for surgeons removing cancer! As Dennis Wise at the U of W explains, "The miniature microscope uses an innovative approach called 'dual-axis confocal microscopy' to illuminate and more clearly see through opaque tissue. It can capture details up to a half millimeter beneath the tissue surface, where some types of cancerous cells originate." It was originally intended for surgeons during cancer removal, to be able to differentiate between healthy tissue versus cancer-laden tissue while excising cancer out of the body, to not only save healthy tissue (especially brain,) but also to ensure no cancer cells are left behind. If successful in the trials, this differentially-diagnosing tool could be so impactful in the dental office, too, as the first defenders against head and neck cancer, highlighting cancerous oral lesions more easily!

Conclusion
All clinical practitioners are encouraged to use a variety of references in their office libraries and online for additional case presentations, and to continuously upgrade and maintain a knowledge base about oral pathology for best practices management for their patients. This course is meant to be a survey of relatively common oral pathology conditions and isnot a substitute for academic instruction. Dentists should refer complex cases to the appropriate specialist after initial consultation and diagnosis.