Understanding Common Oral Pathologies

​Oral pathology centers on diagnosing and treating wide ranging diseases of the gums, teeth, skin, muscles, joints, bones, and glands in the oral and maxillofacial regions, or the area of the mouth. Among the more common issues diagnosed are oral cancer, oral thrush, herpes simplex virus type 1 (HSV-1), and black hairy tongue.

The latter is a condition that results from dead skin cell buildup on the tongue’s papillae. Containing the taste buds, the papillae form from the mucous membrane cells on the tongue’s surface. When these bumps grow excessively long, they are stained by and trap substances such as bacteria, yeast, food, drinks, and tobacco. The result is often a dark, furry tongue appearance and bad breath. A metallic taste may persist in the mouth, and the tongue may have a burning sensation if yeast or bacterial infection occurs. While aesthetically undesirable, the condition is temporary, as one can remove the dead skin cells that have collected through tongue and mouth cleaning, and practicing proper oral hygiene.

Oral thrush, or oral candidiasis, involves a buildup of the fungus Candida albicans in the mouth. The presence of candida yeast is normal in the mouth. A buildup occurs with weakened immunity, diabetes, dentures, or conditions associated with dry mouth. Those who take drugs such as inhaled corticosteroids, prednisone, or antibiotics are also susceptible.

Typical oral thrush symptoms include creamy white patches and red bumps, with raised patches sometimes having a cottage cheese appearance. These affect the inner cheeks, tongue, and occasionally the gums and tonsils, and cause loss of taste and cottonmouth. Pain may persist when swallowing or eating, and the corners of the mouth may experience redness and cracking. When patches are rubbed or scraped, slight bleeding often occurs.

When a person has a weakened immune system associated with HIV/AIDS or cancer, the condition can spread down the esophageal tube. This is known as Candida esophagitis, and it causes pain and the sensation of food getting stuck in the throat. Treating oral thrush typically requires a regimen of antifungal medicines.

HSV-1 is most common in children, but may occur at any age. It tends to start with a burning, tingling, or itching sensation in the lip area, and can progress to painful and swollen blisters on the face, lips, and tongue. Ways of spreading the disease include kissing and sharing lip balm, beverages, and eating utensils. While there is no treatment for the virus, it does typically go away and remain dormant, recurring when one is stressed or has a weakened immune system.

Oral cancers of the oral cavity and pharynx, exceed 50,000 cases and 12,000 deaths in the US each year and are most common among those over the age of 60. They often start with sores or white patches on the lips, tongue, and mouth roof and floor. These resemble less serious conditions but persist and, when untreated, spread throughout the mouth and down into the esophagus.

Identifying oral cancer starts with visual identification and extends to brush or incisional biopsies, with potentially cancerous cells collected and examined in the lab. Treating the disease typically requires primary tumor surgery to remove cancerous cells. It may also include glossectomy, or the partial or full removal of the tongue, and maxillectomy, which involves removing the bony roof of the mouth known as the hard palate. Regular checkups with a dentist, oral surgeon or oral pathologist are recommended to identify such diseases as early as possible, when they are more treatable.

Christopher C. Babcock, The 104th AAOMS Annual Meeting

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