medicine

1. Biopsy
- By, A. Dolin

2. Imaging
Modalities
Presentation Title 2
•Imaging modalities help dentists see inside
the mouth, jaw, and facial bones.
•They are essential for diagnosing dental
problems, planning treatments, and detecting
serious conditions like oral cancer.
Common imaging types
➤ Plain Radiographs (X-rays)
➤ CT Scan (Computed Tomography)
➤ MRI (Magnetic Resonance Imaging)
➤ PET Scan (Positron Emission Tomography)

3. Plain
Radiographs
•Most commonly used dental
imaging.
•Uses low-dose radiation to show
teeth, bone, and cavities.
Includes:
Intraoral X-rays (bitewing,
➤
periapical)
Extraoral X-rays (panoramic)
➤
Dental Uses:
•Detect tooth decay, bone loss,
impacted teeth, or abscesses
•Plan for root canal, braces, or
implants
Presentation Title 3

4. CT Scans •CT (Computed Tomography)
gives a 3D image of teeth, jaw,
sinuses, and nerves.
•In dentistry, CBCT (Cone Beam
CT) is most commonly used.
Dental Uses:
•Plan dental implants accurately
•Diagnose cysts, tumors, or jaw
fractures
•Locate nerves before surgery
•Evaluate sinuses for sinus lifts
Presentation Title 4

5. MRI in
Dentistry
•MRI uses magnets and radio
waves (no radiation).
•Shows soft tissues in great
detail (muscles, joints, nerves,
glands).
Dental Uses:
•Diagnose TMJ disorders (jaw
joint problems)
•Detect salivary gland diseases
or tumors
•Investigate oral cancers or
nerve damage
Presentation Title 5

6. PET Scan
•PET scan shows how tissues and
organs are working, not just their
shape.
•Often combined with CT (PET-CT) for
better detail.
•Uses a small amount of radioactive
sugar, which is absorbed by active or
cancerous cells.
Dental Uses:
•Detect oral cancers and see if they
have spread
•Check if cancer treatment is
working
•Differentiate between benign and
malignant lesions
Presentation Title 6

7. Distant
Metastasis
Imaging
What is Distant Metastasis?
•Metastasis means cancer spreading from one
part of the body to another.
•In oral cancer, cancer can spread (metastasize)
to lungs, liver, bones, or lymph nodes.
•Distant metastasis imaging is done to check if
oral cancer has spread.
Imaging Techniques Used:
•PET-CT Scan – Most common and accurate
• Shows both structure and activity of
tissues
•Chest X-ray – Checks for spread to the lungs
•Bone Scan – Detects cancer spread to the
bones
•MRI/CT of Abdomen or Brain – Used if
symptoms suggest spread to those areas
• A patient with advanced tongue cancer may
get a PET-CT scan to see if the cancer has
reached the lymph nodes or lungs before
surgery or radiation.
Presentation Title 7

8. Vital Staining
What is Vital Staining?
•A method where special dyes are applied to
the mouth to highlight abnormal cells.
•Helps in detecting pre-cancerous or cancerous
areas that may not be easily visible.
•Used in oral cancer screening.
Common Vital Stains:
•Toluidine Blue – Stains areas with high DNA
activity (often cancer cells)
•Lugol’s Iodine – Stains normal tissues, leaving
abnormal areas unstained
•Rose Bengal or Methylene Blue – Occasionally
used
Dental Uses:
•Early detection of oral cancer or leukoplakia
(white patches)
•Guide biopsy by highlighting suspicious areas
•Used during regular screening for high-risk
patients (tobacco or alcohol users)
• A dentist applies Toluidine Blue to a
suspicious white patch on the tongue. The
area turns dark blue, suggesting that a
biopsy is needed to rule out cancer.
Presentation Title 8

9. Exfoliative
Cytology
•A simple, non-surgical test used to
examine cells shed from body surfaces.
•In dentistry, it's used to check cells from
the lining of the mouth.
•Helps in early detection of oral cancer or
pre-cancerous conditions.
Dental Uses:
•Screen for oral cancer, especially in
patients who use tobacco or alcohol.
•Check suspicious white patches
(leukoplakia) or red patches
(erythroplakia).
•Follow-up for recurrence in treated
cancer patients.
Presentation Title 9

10. How is Exfoliative
Cytology Done?
1.The area (e.g., cheek, tongue, or lesion)
is cleaned and dried.
2.A spatula or brush is used to gently
scrape or brush the surface.
3.The collected cells are spread on a
glass slide.
4.The slide is fixed and stained in a lab.
5.A pathologist examines the cells under
a microscope.
Advantages:
•Quick and painless
•No surgery or anesthesia needed
Limitations:
•May miss deep lesions
•Not a replacement for a biopsy
Presentation Title 10

11. Types of
Exfoliative
Cytology
1, Spontaneous Exfoliation
•Cells that naturally fall off (e.g., in
saliva or ulcers).
2. Mechanical Exfoliation
•Cells are collected by brushing,
scraping, or swabbing.
3. Liquid-Based Cytology
•Cells are collected and placed in
liquid, then processed for better
slide quality.
4. Brush Biopsy (OralCDx)
•A special brush collects cells from
all layers, increasing accuracy.
Presentation Title 11

12. Papanicolaou (Pap)
Classification
System
Presentation Title 12
•Developed by Dr. George Papanicolaou.
•Used to grade the changes seen in the
cells.
•The classification has five classes (I–V)
based on how normal or abnormal the cells
appear.

13. Class I & Class
II
Class I: Normal
•All cells look healthy.
•No signs of cancer or abnormal
changes.
Example:
Healthy patient, no lesion, or a
benign ulcer.
Class II: Atypical but Non-Cancerous
•Some minor changes, but no
cancer.
•Could be due to inflammation or
infection.
Example:
Mild irritation from a sharp tooth or
cheek biting.
Presentation Title 13

14. Class III & Class
IV & Class V
Class III: Uncertain/Questionable
•Cells show changes that may be pre-cancerous.
•Needs biopsy to confirm diagnosis.
Example:
White or red patch showing irregular cells under
the microscope.
Class IV: Suggestive of Cancer
•Cells look very abnormal, but not enough to
confirm cancer.
•Strong recommendation for biopsy and further
testing.
Example:
A non-healing lesion in a smoker showing
irregular, enlarged nuclei in cells.
Class V: Positive for Cancer
•Cells clearly look malignant (cancerous).
•Immediate treatment and full diagnostic work-
up needed.
Example:
Ulcer on the tongue with cancer cells detected
under the microscope.
Presentation Title 14

15. Oral Biopsy
•An oral biopsy is a medical test.
•A small piece of tissue is
removed from the mouth
(tongue, gums, cheek, or jaw).
•The tissue is then checked
under a microscope.
•Doctors do this to find out if a
sore, lump, or lesion is
cancerous or has any other
disease.
•It helps in early diagnosis and
treatment.
Example:
If you have a white patch on
your tongue that won’t go away,
your dentist may suggest an
oral biopsy to check if it's
Presentation Title 15
(a medical test)
20XX

16. Why is an Oral Biopsy Done?
Characteristics: Types:
Presentation Title 16
20XX
Types of Oral Biopsies
• Excisional Biopsy – whole lesion is removed.
• Incisional Biopsy – only part of the lesion is removed.
• Needle Biopsy – tissue taken with a needle.
• Brush Biopsy – cells collected using a small brush.
Aftercare Tips
• Avoid hot/spicy foods for 1–2 days.
• Follow dentist's instructions for pain relief.
• Keep the area clean to avoid infection.
• Healing usually takes a few days to a week.
•To identify abnormal growths or lesions.
•To check for oral cancer or pre-cancer.
•When a sore doesn’t heal in 2-3 weeks.
•To investigate pain, swelling, or bleeding without a clear
reason.
•For long-term ulcers or red/white patches in the mouth.

17. Excisional
Biopsy
•Entire lesion is removed, including some
surrounding healthy tissue.
•Used when the lesion is small, appears benign, or
easy to remove completely.
Dental Uses:
•For small growths, lumps, or ulcers that can be
taken out entirely.
•Helps both diagnose and treat at the same time.
Steps:
1.Area is numbed with local anesthesia.
2.The whole lesion is cut out.
3.Tissue is sent to a lab for microscopic examination.
4.Wound is stitched if needed.
Example in Dentistry:
A small fibroma (caused by chronic cheek biting) is
excised in one visit and sent for testing.
Advantages:
•Removes problem area completely.
•Usually no need for another biopsy.
Limitations:
•Only suitable for small lesions.
•Cannot be used if the lesion is too large or close to
vital structures (like nerves or vessels).
Presentation Title 17

18. Incisional
Biopsy
•Only a small part of the lesion is removed.
•Used when the lesion is large, irregular, or possibly
malignant (cancerous).
Dental Uses:
•For suspicious non-healing ulcers, white/red patches,
or oral cancer screening.
•To get a sample without removing the entire lesion.
Steps:
1.
Area is numbed.
2.
A representative section of the lesion is selected
(often the edge).
3.
A slice of tissue is removed and sent to the lab.
4.
Patient may be scheduled for further treatment
based on the result.
Example in Dentistry:
A large red-and-white patch on the tongue is sampled
with an incisional biopsy to check for dysplasia or
cancer.
Advantages:
•Helps diagnose large or deep lesions.
•Can guide treatment planning for oral cancer or
other diseases.
Limitations:
•Lesion is not removed fully may still require surgical
removal or additional procedures.
Presentation Title 18

19. Needle Biopsy
•A thin needle is inserted into a lump or swelling to
collect cells or fluid.
•It’s a minimally invasive procedure no large cuts or
stitches.
Dental Uses:
•To test swollen lymph nodes in the neck or jaw.
•To check if a lump near the oral cavity is cancerous or
infected.
•Often used for suspected metastatic cancer or deep
lumps hard to biopsy surgically.
Procedure Steps:
1.
Area is cleaned; local anesthesia may be used.
2.
Thin needle is inserted into the lump.
3.
Cells/fluid are withdrawn with a syringe.
4.
Sample is placed on a slide or sent for lab analysis.
Example in Dentistry:
A patient has a persistent neck swelling after oral
cancer diagnosis; FNA helps confirm if cancer has
spread.
Advantages:
•Quick, safe, and outpatient procedure.
•Minimal discomfort and no stitches.
Limitations:
•Sometimes sample may be too small for definitive
diagnosis.
Presentation Title 19

20. Brush Biopsy
•A special brush is used to collect cells from all layers of
the oral mucosa.
•Non-invasive and painless method to screen for
abnormal or precancerous cells.
Dental Uses:
•For suspicious white or red patches that are not easily
diagnosed.
•Useful in screening patients with high risk factors
(smoking, alcohol).
•Helps to decide if a surgical biopsy is needed.
Procedure Steps:
1.
Dentist brushes the suspicious area with a soft brush
until pinpoint bleeding occurs (to get deep cells).
2.
Cells collected on the brush are transferred to a glass
slide or liquid medium.
3.
Sent for cytological examination.
Example in Dentistry:
A persistent leukoplakia (white patch) on the cheek is
tested using a brush biopsy before deciding on surgery.
Advantages:
•Painless and quick, no anesthesia needed.
•Good for early detection of cell changes.
Limitations:
•Cannot replace surgical biopsy if abnormal cells are
detected.
•May miss deeper lesions if superficial cells are normal.
Presentation Title 20

21. THANK YOU!
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