Journal of Dental Pathology and Medicine
Open Access

Oral pathology; Oral lesions; Diagnosis; Oral cancer; Leukoplakia; Oral lichen planus; Oral candidiasis; Periapical cyst; Histopathology; Treatment strategies; Oral diseases; Squamous cell carcinoma

Introduction

Oral pathology is a specialized field of dentistry that deals with the study, diagnosis, and management of diseases affecting the oral cavity and surrounding structures [1]. It plays a crucial role in identifying conditions ranging from benign lesions to malignant cancers. This article provides an in-depth overview of common oral pathologies, diagnostic techniques, and current treatment strategies. Oral pathology encompasses the study of diseases affecting the mouth, jaws, and related tissues [2]. It includes both clinical and microscopic analysis of tissue specimens to determine the nature of the condition. Accurate diagnosis is vital for formulating effective treatment plans and preventing disease progression [3]. The oral cavity serves as a vital gateway to the human body, performing essential functions such as mastication, speech, and sensory perception. It is constantly exposed to a variety of physical, chemical, and microbial agents, making it susceptible to a broad spectrum of pathological conditions [4]. Oral pathology, a critical subspecialty within dentistry and pathology, focuses on understanding the nature, causes, and effects of diseases that affect the oral and maxillofacial regions [5]. Much oral pathology, although initially benign in appearance, can progress into chronic or life-threatening conditions if not properly diagnosed and treated [6]. For instance, lesions like leukoplakia may undergo dysplastic changes, potentially leading to oral squamous cell carcinoma, a condition with a high global disease burden. Similarly, seemingly innocuous presentations such as persistent ulcers or erythematous patches may be early indicators of autoimmune disorders or malignancies [7].

Despite the availability of advanced diagnostic tools, many oral diseases are misdiagnosed or detected at advanced stages due to non-specific clinical signs, lack of awareness, or inadequate access to specialized care. Therefore, a strong foundation in oral pathology is essential for clinicians to make informed decisions regarding differential diagnosis and therapeutic planning [8].

This paper aims to provide a concise yet thorough overview of the most common oral pathologies encountered in dental practice. It discusses their etiology, clinical features, diagnostic protocols, and current treatment modalities. By emphasizing both fundamental concepts and recent advances, the review underscores the importance of a multidisciplinary approach to improving diagnostic accuracy, patient outcomes, and overall oral health.

Common oral pathological conditions

Developmental abnormalities in the oral cavity can occur due to genetic, environmental, or idiopathic factors. Common developmental oral pathologies include:

Cleft lip and palate, congenital deformities caused by incomplete fusion of the maxillary and nasal processes.

Macroglossia, an enlarged tongue often associated with conditions like Down syndrome and hypothyroidism.

Torus palatinus and torus mandibular are benign bony outgrowths commonly seen on the hard palate or lingual aspect of the mandible.

Inflammatory oral conditions may be caused by bacterial, viral, or fungal infections.

Oral candidiasis, a fungal infection caused by Candida albicans, presenting as white, curd-like plaques on the oral mucosa.

Herpes simplex virus (HSV) causes painful vesicles and ulcers on the lips and oral mucosa.

Lichen planus, a chronic inflammatory condition with a characteristic reticular or lace-like white appearance.

Premalignant lesions have the potential to transform into oral cancer if left untreated. These include,

Leukoplakia, a white patch that cannot be scraped off and may show dysplastic changes.

Erythroplakia, a red, velvety lesion with a higher risk of malignant transformation compared to leukoplakia.

Oral submucous fibrosis (OSMF), a chronic condition associated with areca nut chewing, leading to fibrosis and increased risk of squamous cell carcinoma.

Oral cancers are a significant concern in oral pathology. Common malignant conditions include,

Squamous cell carcinoma (SCC), the most common oral malignancy, often linked to tobacco and alcohol use.

Mucoepidermoid carcinoma, a salivary gland malignancy with varying degrees of aggressiveness.

Adenoid cystic carcinoma, a slow-growing but highly invasive salivary gland tumor.

Diagnostic techniques in oral pathology

A thorough clinical examination is the first step in diagnosing oral diseases. This includes,

• Visual inspection of oral mucosa.
• Palpation of tissues and lymph nodes.
• Assessment of patient history and symptoms.

Biopsy is the gold standard for diagnosing oral pathology. Types of biopsies include,

• Incisional biopsy, removal of a portion of the lesion for examination.
• Excisional biopsy, complete removal of the lesion.
• Fine-needle aspiration cytology (FNAC), used for salivary gland lesions.

Tissue specimens are processed and stained for microscopic evaluation. Hematoxylin and eosin (H&E) staining is commonly used, along with immunohistochemistry (IHC) for specific markers.

Imaging techniques aid in identifying bone and soft tissue pathologies,

• Panoramic radiography (OPG), provides a broad view of the jaws.
• Cone-beam computed tomography (CBCT), offers detailed 3D imaging of oral structures.
• Magnetic resonance imaging (MRI), useful for assessing soft tissue involvement.
• Antifungal agents, nystatin and fluconazole for oral candidiasis.
• Antiviral drugs, acyclovir for herpes simplex infections.
• Steroids, topical or systemic steroids for inflammatory conditions like lichen planus.
• Excision of benign lesions, removal of fibromas, papillomas, or cysts.
• Resection of malignant tumors, combined with radiation and chemotherapy in advanced cases.
• Reconstructive surgery, in cases of large tumor excision, involving bone or soft tissue reconstruction.

Laser treatment is used for:

• Removing benign lesions.
• Treating premalignant lesions with reduced scarring.
• Pain management in mucosal disorders.

Recent advances in oral pathology

• Molecular diagnostics, the use of biomarkers, such as p53 and Ki-67, for detecting early malignancy.
• Saliva-based diagnostics, salivary biomarkers are emerging as non-invasive diagnostic tools for oral cancer detection.
• Artificial intelligence (AI), machine learning algorithms aid in analyzing histopathological images, enhancing diagnostic accuracy.

Conclusion

Oral pathology plays a vital role in diagnosing and managing diseases of the oral cavity. Early detection of potentially malignant lesions is essential to improve patient outcomes. With advancements in molecular diagnostics and AI, the future of oral pathology is poised for more precise and efficient disease identification and management.