Growths and Tumors

In addition to routine surgical procedures that are performed by our practice on a daily basis we also treat pathology of the mouth and jaws.  Often times during a routine dental evaluation dark or bright white spots will appear on dental x-rays.  Impacted teeth such as third molars or wisdom teeth can lead to the formation of cysts and tumors.  Impacted teeth can also result from the presence of a mass or growth preventing the tooth from taking its place in the mouth.  Any growth that is not a normal part of the anatomy is considered a tumor.  These tumors can be either benign or malignant and may or may not be give the patient symptoms such as pain, swelling or numbness.  Your general dentist will then refer you to a specialist for evaluation of these areas or lesions on the x-ray.  And while most often these areas are nothing to be concerned over, being vigilant and fully investigating the possible issues is certainly warranted.

When you arrive at our practice our doctors and staff will review all the relevant medical information and discuss these issues with you.  The initial step in treatment of these possible jaw tumors is confirming that they exist with a three dimensional image or CT scan.  Our office is equipped with a Cone Beam 3D scanner and panoramic x-ray which can be used to distinguish radiographic anomalies from true cysts and tumors.  Repeating the x-ray from your dentist can help distinguish shadows or other positional issues from true problems.  The doctors at our practice will then review these images with you and explain what is found and then discuss recommendations for treatment.  While the x-rays help confirm the presence of a cyst or tumor there is no definitive way to tell what type of tumor it is by x-ray alone.

Most dark lesions on an x-ray are cystic in nature and should be surgically treated with biopsy.  Removal of the cyst and evaluation microscopically will determine if further intervention is necessary.  The reasoning behind these recommendations is that while statistically most cysts are benign, (not cancerous) most will continue to grow over time and be destructive to the surrounding bone and teeth.  Leaving a benign cyst untreated can lead to significant deformity, fractures of the jaw bone, loss of teeth and gums, and malocclusion.  Some larger or more aggressive tumors may need to be treated more radically with a procedure called resection.  This entails removing a large section of the jaw involved to prevent the tumor from reoccurring.  This is only necessary in a small fraction of cysts and will be discussed and planned out well after the initial diagnosis is made.

White or bright areas on the x-rays are less often associated with a need for surgical intervention.  The vast majority of these lesions are simple areas of rapid bone growth called condensing osteitis.  This is a benign condition and surgical treatment is not required.  What makes the white lesions more concerning is that a small number of these areas may be a form of bone cancer.  This is usually easy to distinguish on early images and CT scans but as with all forms of cancer, the treatment is more urgent.

If your general dentist or primary care physician has recommended a consultation with a specialist for a growth or tumor the doctors and staff of Pottstown Oral and Maxillofacial Surgery can help guide you through this process.  Please contact our office for a consultation appointment for assistance.

The Importance of Oral Cancer Screening (OCS)

Every six months, usually during your dental hygiene appointment, your dentist and hygienist will perform an intraoral examination.  They’re not just looking for cavities; they are also looking for any pathology that may have developed in your mouth since your previous visits.  They may also be checking to make sure that certain areas that they are monitoring have not gotten larger or have gone away since your last visit.  This process is called an Oral Cancer Screening (OCS) and is a vital component in the prevention and early detection of oral cancer.  If your dentist sees something unusual, they typically refer you to an oral and maxillofacial surgeon or more rarely an oral pathologist or otolaryngologist.

When you arrive at the oral surgeon’s office, the examination will be repeated.  We are looking for anything that your dentist may have missed on their exam and more importantly to identify and diagnose the area of concern.  The vast majority of lesions, cysts, tumors and other abnormal findings in the mouth are totally and completely benign (non-cancerous).  Most often, however, if we can confirm the presence of something abnormal in the mouth a biopsy is recommended.  This does not mean that something bad is going on.  It is extremely difficult and sometimes impossible to visually tell the difference between certain variations and similar looking pathologic conditions.  The only way to obtain a definitive diagnosis of your problem is to have the tissue examined under a high powered microscope at a pathology lab.  Your surgeon is trying to make an accurate diagnosis so that we can accurately treat the condition.  Once our suspicions are confirmed or an accurate diagnosis is obtained you will have the diagnosis reviewed at your reevaluation appointment, typically one week later.

As with all the procedures in our office, the biopsy procedure can be performed either with local or general anesthesia.  Some larger conditions due to the size or location of the lesion are best removed under sedation or general anesthesia for our patient’s comfort and/or safety.  Talk with your surgeon about your treatment options.  You may choose to have the area reevaluated and defer the biopsy procedure until a later date.  As with everything there are positive and negative aspects of having or not having the biopsy performed.  Rarely a biopsy result will be reviewed with some variety of oral cancer.  The treatment in these cases all depend on the size of the area, location of the lesion and progression of the disease.  By recommending biopsy in most cases we are trying to detect an issue as early as possible to prevent spread or progression of the disease.  All of these issues should be discussed with your treating surgeon at the consultation appointment.  The goal of the entire team involved in the care of our patients is the detection, prevention and appropriate treatment of all oral pathology.