Introduction

Snapshots in Oral Pathology

The full range of practice for which oral and maxillofacial pathologists are trained includes four principal areas: microscopic and laboratory diagnosis, clinical evaluation and management of patients, teaching, and research. Just as general dentists perform a variety of procedures on a daily basis, oral pathologists perform some or all of their prescribed functions daily. To capture a sense of this multiplicity, I have asked a select group of highly regarded oral pathologists to contribute papers of their choosing that embody one or more of the four cornerstones of an oral pathologist's practice. The result is an eclectic mix of subjects I call "Snapshots in Oral Pathology."

Dr. Joseph Regezi, of the University of California at San Francisco, has accumulated a number of cases that masqueraded as garden-variety periapical inflammatory disease but, upon biopsy, proved to be anything but routine periapical disease. His paper resoundingly makes the point that everything is not always what it appears to be.

Recently, an editor in a major journal was critical of oral pathologists' contention that pathologic periapical tissues removed as a component of surgical treatment ought to be sent for microscopic examination. The man's reasoning was based upon cost-effectiveness. In other words, is it worth it to have confirmed microscopically that you were indeed treating the disease you thought you were? If each of us were always correct in our clinical diagnoses, the answer would be no. As Dr. Regezi's paper makes clear, a host of both innocent and dangerous conditions can mimic periapical inflammatory processes. It might be merely embarrassing but it could be tragic to have to face a patient after treatment failure had finally necessitated a biopsy and disclose that diagnostic tissue had been discarded in favor of some supposed economy.

In the same general vein, Dr. Mark Bernstein, of the University of Louisville, presents eminently useful information on a range of inflammatory mucosal lesions that result from tissue reactions to restorative materials, medications, or food. His paper provides both information and sound advice on the approach to diagnosis based upon his clinical experience and research.

Dr. Robert Greer, of the University of Colorado, discusses his experiences in diagnosis, management, and follow-up of two patients with proliferative verrucous leukoplakia. This serious, enigmatic disease is becoming more widely recognized, but its etiology and means of effective treatment continue to elude us.

Dr. Janice Handlers, of the University of Southern California, presents clinically relevant information on the oral manifestations of certain diseases of the gastrointestinal system. For centuries, astute physicians have recognized that the mouth mirrors the health of the rest of the body. Dr. Handlers describes, for example, how two diverse, common diseases such as peptic ulcers and colon polyps can share anemia as a side effect and that this, in turn, has significant oral manifestations. She points out that patients with certain types of inflammatory bowel disease can develop oral lesions that, when biopsied, may cause an oral pathologist to predict the systemic problem.

Finally, Dr. George Kaugars and his associates, of the Medical College of Virginia, offer a most practical and informative discussion of ultraviolet radiation -- its types and effects on the skin and vermilion border of the lip. Their discussion of the types and mechanisms of action of common sunscreen agents is very practical for dentists in California since many are often queried by patients about this topic.

Although there is not a unifying theme among the papers that constitute the bulk of this month's issue of the Journal of the California Dental Association, it is my sincere hope that readers, and by extension their patients, will benefit from the information offered by this group of noted oral and maxillofacial pathologists. If readers have one or more specific topics they would like to have addressed in future issues of the Journal that may be devoted to topics in oral and maxillofacial pathology, I would be pleased to hear from them directly or by in writing in care of the Journal.