Oral and Maxillofacial Pathology is a specialized field in dentistry and pathology that focuses on understanding, identifying, and treating diseases that impact the oral and maxillofacial region. It involves investigating the reasons behind these diseases, how they develop, and their effects. Practitioners in this field conduct research and diagnose diseases using various methods such as clinical assessments, X-rays, microscopic examinations of the biopsy specimens, and biochemical tests. OMFP is closely allied to the science of Oral Surgery and Oral Medicine. Also, it is closely related to general medicine and pathology.[1]
Oral pathologists work closely with Oral and Maxillofacial radiologists. This specialized dentistry field uses various imaging techniques to diagnose and assess conditions and diseases related to the oral and maxillofacial (mouth and face) region. These imaging techniques include X-rays, CT scans, MRIs, and other advanced technologies. Oral radiologists collaborate with dentists, oral surgeons, and other healthcare providers to interpret these images, provide accurate diagnoses, and contribute to treatment planning for dental and oral health issues.[2]
Oral and Maxillofacial Pathologies Conditions
The prevalence of oral and maxillofacial pathology (OMFP) conditions can vary widely and be influenced by factors such as geographic location, age, gender, and lifestyle. Some OMFP conditions are common, while others are rare. The list of oral systemic diseases and oral maxillofacial pathologies is extensive, and it becomes particularly challenging, especially when considering systemic causes [Table 1].
Table 1: Systemic diseases with Oral Manifestations
| Category | Example |
|---|---|
| 1. White and Red Blood Cell lineage disorders | Leukemia, Lymphoma Multiple myeloma Polycythemia vera Largerhans cell histiocytosis Anemia (sick cell disease, thalassemia.) |
| 2. Bleeding Disorders | Hemophilia A and B Von Willebrand disease Ehler-Danlos syndrome Scurvy disease |
| 3. Pancytopenia | Aplastic Anemia Falconi anemia |
| 4. Liver Diseases | Hepatitis C Alcohol-induced Drug toxicity Autoimmune hepatitis Biliary cirrhosis Liver transplantation |
| 5. Kidney diseases | Renal failure ESRD Kidney transplantation |
| 6. Connective Tissue Diseases | Lupus erythematosus Scleroderma Sjogren syndrome Rheumatoid arthritis Juvenile idiopathic arthritis |
| 7. Endocrine Diseases | Diabetes mellitus Hypothyroidism Hyperthyroidism Addison’s Disease Multiple endocrine neoplasia syndrome, Schwartz-Bartter syndrome |
| 8. Pulmonary Diseases | Asthma Broncho-pulmonary dysplasia Chronic obstructive pulmonary disease Obstructive Sleep apnea |
| 9. Immunologic Diseases | Angioedema Behçet disease Autoimmune inflammatory diseases: *Aphthous-stomatitis *Pharyngitis *Adenitis *Familial Mediterranean fever *Hyperimmunoglobulinemia D periodic fever syndrome *Tumor necrosis factor receptor-associated periodic syndrome *Pyogenic sterile arthritis *Pyoderma gangrenosum acne |
| 10. Nutritional Deficiencies | Vitamin A (retinol Vitamin B12 (riboflavin) Vitamin B3 (niacin), Vitamin B6 (pyridoxine), Vitamin B7 (biotin), Vitamin C (ascorbic acid), Vitamin K (phylloquinone), Iron Vitamin B9 (folate) Vitamin B12 |
| 11. Dermatologic Diseases | Lichen planus Pemphigus Paraneoplastic pemphigus Pemphigoid Erythema multiforme Acanthosis nigricans Sweet syndrome Peutz-Jeghers syndrome Osler-Weber-Rendu syndrome |
| 12. Vascular Diseases | Cyanotic and noncyanotic congenital heart disease Hypertension Polyarteritis nodusa Giant cell artheritis |
| 13. Gastrointestinal Diseases | Celiac disease Crohn’s disease Ulcerative colitis Gastric regurgitation *Acid reflux *Pernicious anemia *Plummer-Vinson syndrome |
| 14. Metastatic Carcinoma | Breast, Lung, Prostate, Liver, Kidney, Colorectum’s cancers |
| 15. Other | Amyloidosis, Neurofibromatosis type 1, 2, HIV, Infectious mononucleosis, Varicella, Measles, Herpangina, Candidemia, Tuberculosis, Histoplasmosis, Sarcoidosis, Neuropathies |
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Oral pathology specialists and practitioners practice in laboratory and clinical settings dealing with several conditions (Table 2).
Table 2. More Common Conditions in Oral and Maxillofacial Pathology
| Category | Example |
|---|---|
| 1. Odontogenic tumors | Ameloblastoma Odontoma Adenomatoid Odontogenic tumor Ameloblastic Fibroma Central Odontogenic Fibroma Odontogenic Myxoma |
| 2. Bone Pathologies (non-odontogenic tumors) | Simple Bone cyst Idiopathic Osteosclerosis Central Giant cell granuloma Osteoma Fibrous Dysplasia Paget Disease Cherubism Central Ossifying Dysplasia Metastatic Carcinoma (Lung, Breast, Prostate among other) Osteosarcoma |
| 3. Fungal Infections | Pseudomembranous Candidiasis Hyperplastic Candidiasis Denture stomatitis Aspergillosis |
| 4. Epithelial lesions | Leukoplakia Erytroplakia Lichen Planus Verrucous Leukoplakia SCC Squamous papilloma Hyperkeratosis Verruca vulgaris Epithelial dysplasia |
| 5. Soft tissue tumors | Lipoma Fibroma Giant Cell fibroma Neurofibroma Pyogenic Granuloma Peripheral Giant cell granuloma Peripheral Ossifying fibroma Inflammatory Fibrous hyperplasia |
| 6. Salivary gland disease | Mucocele Ranula Retentions Cyst Sialolithiasis |
| 7. Benign salivary gland tumor | Pleomorphic Adenoma Warthin’s tumor |
| 8. Malignant salivary gland tumor | Adenoid Cystic carcinoma Mucoepidermoid Carcinoma Acinic Cell Carcinoma |
| 9. Infectious bone diseases | Medicated-related osteonecrosis of the jaw Osteoradionecrosis Osteomyelitis |
Oral and Maxillofacial Pathology and Radiology Professional Organizations and Certifications
The American Board of Oral and Maxillofacial Pathology (ABOMP) specialty was approved and recognized by the ADA in 1950 and the American Board of Oral and Maxillofacial Radiology (ABOMR) specialty was approved by the ADA in 1999. Both organizations are very well recognized and respected. They are responsible for certifying and maintaining the high standards of professional competence among oral and maxillofacial pathologists and radiologists in the United States. After passing the certification examination, which is administered by each organization the Oral and Maxillofacial pathologists and radiologists must engage in ongoing professional development to ensure they stay current with advancements in the field and meet recertification requirements to maintain their certification.
Nowadays, 16 institutions are offering Oral and maxillofacial pathology programs, and 10 institutions offering Oral and maxillofacial radiology in the U.S. where dentists can obtain certificates, master’s degrees, and/or Ph.Ds. These programs are typically specialized and focused on diagnosing and managing oral and maxillofacial conditions.
The importance of a Multidisciplinary Approach in the Oral health care
OMFPs are diverse and diagnostically challenging, these pathologies comprise a variety of differential diagnoses, extending from developmental abnormalities, and reactive conditions to neoplastic growths. Oral pathologists heavily depend on a comprehensive approach, which includes firsthand inspection of clinical impressions, thorough examination of medical and dental histories, evaluation of relevant tissue specimens, and the review of radiographs, typically Panorex, CBCT, and or MRI.
The complex and diverse nature of oral pathologies justifies the multidisciplinary approach that involves not only Oral and Maxillofacial Pathologists and Radiologists but also a wide range of dental and medical specialists. These include Oral and Maxillofacial surgeons, General dental clinicians, Oral medicine, Orofacial pain specialists, Primary physicians, Physician pathologists, ENT, dermatologists, Infectiologist, oncologists, cardiologists, and others. The interdisciplinary approach provides critical clinical clues that can help favor one diagnosis over another. The primary objective of the entire healthcare team is to achieve early diagnosis, develop an accurate treatment plan, and improve the patient’s overall health.
Conclusion
The expertise and studies of Oral Pathologist and Oral Radiologist professionals play a vital role in the promotion of oral healthcare. In many cases, obtaining a definitive and precise diagnosis cannot solely depend on clinical evaluation, imaging techniques, histologic studies, salivary diagnostics, cytology combined with molecular assessments, and liquid biopsy (molecular measurements in blood or plasma) become necessary and crucial to achieving an early and correct diagnose of a given disease.
The correct and early diagnosis of the oral mucosa, gingival, and bone manifestations is primordial to provide effective patient management and improve his/her prognosis. Hence, the multidisciplinary approach among oral pathologists, oral radiologists, and dental and medical professionals, is vital for the promotion and ensuring patient’s overall health and well-being.
Medical and dental providers can work together to better serve our patients and contribute to the promotion of their overall health. By being attentive to the relationship between the oral cavity and the rest of the body, recognize and be aware of oral manifestations of systemic disease. Effective communication among healthcare providers, evaluation of patient’s medical and dental histories, and seeking and referring the patient for second opinions or additional investigations when uncertainty arises are essential practices for the success and promotion of patient wellness.
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Learn more about the clinical and didactic skills necessary to evaluate and manage patients with oral diseases by enrolling in Herman Ostrow School of USC’s online, competency-based certificate program in Oral Pathology and Radiology.
References
- American Board of Oral and Maxillofacial Pathology https://abomp.org
- American Academy of Oral and Maxillofacial Radiology https://aaomr.org
- World Health Organization https://www.who.int/news-room/fact-sheets/detail/oral-health
- Oral mucosal changes associated with primary diseases in other body systems. Elad S, Zadik Y, Caton JG, Epstein JB. Periodontol 2000. 2019 Jun;80(1):28-48. doi: 10.1111/prd.12265. PMID: 31090141.
- COLOR ATLAS OF ORAL AND MAXILLOFACIAL DISEASES- Elsevier 2019
- Oral and Maxillofacial Pathology – Neville 3nd. edition
- Metastatic tumors in the jaw bones: A retrospective clinicopathological study of 12 cases at Tertiary Cancer Center. Nawale, Kundan Kisanrao; Vyas, Monika1; Kane, Shubhada2; Patil, Asawari2,. Journal of Oral and Maxillofacial Pathology 20(2):p 252-255, May–Aug 2016. | DOI: 10.4103/0973-029X.185920
- Oral Manifestations of Systemic Diseases Updated: Jun 29, 2018 Author: Heather C Rosengard, MPH; Chief Editor: Dirk M Elston, MD more… https://emedicine.medscape.com/article/1081029-overview#a10
- Relationship Between Disorders in the Oral Cavity and Systemic Disease. Casamassimo PS, Flaitz CM, Hammersmith K, Sangvai S, Kumar A. Recognizing the Pediatr Clin North Am. 2018 Oct;65(5):1007-1032. doi: 10.1016/j.pcl.2018.05.009. PMID: 30213346.
