Dental Specialties 5 Oral Pathology

Oral Pathology (also called Oral Medicine and Pathology) is the specialty of dentistry concerned with diagnosis and treatment of diseases and disorders of the mouth and lower face.  This also includes the regular dental treatment of patients with medical complications.  This is a specialty that takes care of unusual cases when diagnosis might be quite complicated.  Nearly all of the Oral Pathologists on this side of the world are employed by either a dental school or the government.  Many operate part time private practices in addition to teaching or working for the government.

     When I was in dental school, I had the opportunity to shadow a noted oral pathologist in his duties for several days.  I came to understand that these specialists often take care of patients with unusual symptoms and often a long course of difficulty because of conditions whose origins are elusive.  The fellow I shadowed was an expert in diagnosis and treatment of pain syndromes.  He spent a lot of time interviewing the patients about their conditions and trying to understand all the aspects of their complicated dental problems and problems of the lower face and neck.  I came to understand that his treatments were often quite simple, but the diagnosis usually was difficult and sometimes time consuming.  He also spent some time with a microscope and photos and descriptions of over 40 years of past cases to help him understand the cases he was currently evaluating.  He liked to say that there are many possible treatments that would likely be effective, but only one correct diagnosis.

     In normal general dental practice, the services of an oral pathologist are needed when the symptoms do not point to a common dental problem, or sometimes even to a single dental specialty.  As well, when a soft or hard tissue growth needs to be evaluated and possibly removed, often an oral pathologist can help.  We are fortunate to have several oral pathologists available in Winnipeg who are associated with the U of Manitoba dental school and make themselves available to our patients if needed.  Just as when I was shadowing the Oral Pathologist at the University of Iowa, I have found our Oral Pathologists to be very insightful and usually have simple solutions for very complex problems.      

     As an example, I had a patient with a history of minor trauma to a quadrant of the mouth many years ago.  Over the years, several teeth one by one displayed the symptoms of dental abscess.  Root canal treatment was performed and offered complete relief for a few years until another tooth in the same area displayed symptoms of dental abscess.  None of the teeth had deep decay.  None of the teeth were cracked, but one by one they displayed all the symptoms of dental abscess, most notably acute pain completely isolated to one tooth.  After a 30 year history like this, the root canal treated teeth again one by one showed the symptoms of abscess and the root canals looked like they had been done perfectly.  What is wrong with this case?  I have had one case like this in my nearly 17 years of dental practice.  At length, I referred the case to an Oral Pathologist who diagnosed trigeminal neuralgia (a nerve condition) on this patient that had mimicked dental abscesses intermittently for over 30 years and through four different dentists (two of whom were endodontists--and two of us were general dentists) who had completed the separate root canals on the teeth.  As you can likely surmise because I have only seen one case like this in 17 years, this sort of condition is quite unusual.  Once the condition was diagnosed, its treatment has become much more manageable.  This is the kind of case an Oral Pathologist takes care of on a regular basis.

 

 

This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)