An oral biopsy is a minor surgical procedure where a small tissue sample is removed from an abnormal area inside the mouth (e.g., tongue, cheek, or gum). This sample is sent to a laboratory for microscopic examination. The primary purpose is to accurately diagnose the nature of the oral lesion, determining if it is a benign change, an infection, or a potentially precancerous or cancerous condition.
The Healthcare Professionals Who Perform Biopsies
The choice of practitioner who performs an oral biopsy depends largely on the size, location, and complexity of the identified lesion. Oral and Maxillofacial Surgeons (OMFS) are the specialists most frequently involved, especially for larger growths, lesions extending into the bone, or those requiring general anesthesia. Their extensive training in both dentistry and surgery makes them well-suited for complex tissue removal and reconstruction.
Periodontists, who specialize in the health of the gums, often perform biopsies for lesions located on the gingiva or surrounding soft tissues. Their expertise allows for precise sampling and careful wound closure. For simple, small, and easily accessible soft tissue lesions, a General Dentist may also perform the biopsy in their office.
The tissue sample is sent to an Oral Pathologist, a doctor who specializes in diagnosing diseases of the head and neck region by examining the tissue under a microscope. While the surgeon or dentist performs the physical procedure, the Oral Pathologist provides the definitive diagnosis. In cases where a lesion is located deeper in the throat or neck, an Ear, Nose, and Throat (ENT) specialist, also known as an Otolaryngologist, may be the appropriate surgeon to conduct the biopsy.
When an Oral Biopsy is Necessary
A dental professional recommends an oral biopsy when a suspicious change does not resolve within a reasonable timeframe. The most common indication is a persistent ulcer or sore that has not healed after two weeks, especially if the cause is not an obvious local irritation. A biopsy is a diagnostic tool, not a treatment, used to find the precise cause of the abnormality.
Discolored patches on the mucous membranes often necessitate this procedure because they may signal precancerous changes. White patches, known as leukoplakia, and red patches, known as erythroplakia, are concerning, with erythroplakia carrying a higher risk of malignancy. Any unexplained lump, mass, or growth in the soft tissues of the mouth, tongue, or jaw also warrants a biopsy to determine its cellular composition.
The procedure may also be necessary to diagnose chronic inflammatory conditions or autoimmune disorders that manifest as lesions in the mouth. The decision to proceed is based on the lesion’s appearance, its persistence, and the clinical judgment of the practitioner. Biopsies allow for a definitive, microscopic analysis that cannot be achieved through visual inspection or imaging alone.
How the Oral Biopsy Procedure is Performed
The oral biopsy is typically performed in an outpatient setting using local anesthesia to numb the area, similar to a routine dental filling. This ensures the patient experiences no pain during tissue removal, though a slight pinch may be felt when the anesthetic is administered. The entire surgical procedure is usually brief, often taking less than 30 minutes.
The practitioner will select one of two main techniques: an incisional or an excisional biopsy. An incisional biopsy involves surgically removing only a small, representative wedge of the abnormal tissue along with a sliver of surrounding normal tissue for comparison. This approach is used for larger lesions or when the lesion is suspected to be malignant, as it helps determine the diagnosis before planning a more extensive removal.
Conversely, an excisional biopsy removes the entire lesion in one piece and is usually reserved for small lesions that appear benign upon visual examination. Following removal, the site is often closed with sutures, which may be dissolvable within one to two weeks. The collected tissue is placed in a preservative solution and sent immediately to the pathology laboratory for analysis.
Recovery and Receiving Biopsy Results
Immediately following the procedure, patients receive instructions to manage initial bleeding and discomfort. Gentle pressure applied with sterile gauze is usually sufficient to control any minor oozing. Mild pain and swelling are common for the first few days and are typically managed with over-the-counter pain relievers, such as ibuprofen or acetaminophen.
Patients are advised to limit strenuous activity for the first 24 to 48 hours to minimize bleeding and swelling. A soft, non-acidic, and non-spicy diet is recommended for several days to prevent irritation. Maintaining oral hygiene is important, but patients should avoid brushing or vigorously rinsing the surgical site until it has begun to heal.
The diagnostic step occurs when the Oral Pathologist examines the tissue and prepares a detailed report. The timeline for receiving results can vary, but it usually takes seven to ten business days for the pathology report to be finalized. A follow-up appointment is scheduled with the referring doctor or the surgeon to discuss the results and determine necessary next steps in treatment.