Ep. 637 - Common Oral Pathologies: Best Practices for Dental Professionals

How many of the common oral lesions you encounter in practice could be masking something far more serious than they appear?

Dr. Ashley Clark is an Associate Professor and Division Chief of Oral Pathology at the University of Kentucky College of Dentistry. She holds a DDS from Indiana University and a certificate in Oral and Maxillofacial Pathology from The University of Florida. Dr. Clark has previously served as oral pathology laboratory director at West Virginia University, where she was nominated for the Early Career Innovator Award. At the University of Texas at Houston School of Dentistry, she earned the John H. Freeman Award for Faculty Teaching and the Dean's Excellence Award in the Scholarship of Teaching, along with a Fellowship in Health Education. She has published over 40 papers and abstracts, authored oral pathology sections of both Dental Decks and Dental Hygiene Decks, and serves as a Fellow in the American College of Dentists. Dr. Clark is on the Commission on Dental Accreditation review board for oral and maxillofacial pathology programs and the Advisory Board for Oral Cancer Cause.

This episode provides essential clinical guidance for identifying and managing common oral pathologic entities that every dental practitioner encounters. Dr. Clark breaks down the decision-making process for when to watch, monitor, refer, or biopsy suspicious lesions, with particular emphasis on distinguishing between benign presentations and potentially malignant conditions that can mimic harmless lesions.

Episode Highlights:

• Mucoepidermoid carcinomas are the most common malignant salivary gland tumors and prefer the lower lip location, often presenting as cystic lesions that can burst and refill exactly like mucoceles. Any adult with a lower lip mucocele requires excisional biopsy, and any mucocele on the retromolar pad should be considered cancer until proven otherwise.
• Fibromas are the most common mesenchymal tumors in oral practice, but it is impossible to diagnose a fibroma without histologic evaluation. Even experienced practitioners can miss mucoepidermoid carcinomas that present as fibroma-like lesions, making biopsy submission mandatory for all excised tissue.
• For isolated pigmented lesions, practitioners must take a radiograph to identify amalgam particles in the soft tissue. If no amalgam can be proven radiographically, the lesion must be biopsied immediately, as melanomas can look identical to melanotic macules and rapidly progress when diagnosis is delayed.
• Leukoplakia affects 10% of male patients over age 70, with high-risk locations including lateral tongue, ventral tongue, floor of mouth, and lower lip. The average progression time from dysplastic leukoplakia to cancer is two to four years, but there is no benefit to waiting two weeks before biopsy as with ulcerative lesions.
• Lower lip mucoceles require complete excision including removal of the affected minor salivary glands, which appear as small whitish-yellowish lobules. The excision should be performed in a vertical orientation to allow the mucin sac to pop out, followed by careful removal of the causative glandular tissue.

Perfect for: General dentists, oral surgeons, periodontists, and dental hygienists who need practical guidance on oral pathology recognition and biopsy decision-making in everyday practice.

This clinical discussion will help you confidently distinguish between lesions that can be monitored and those requiring immediate histologic evaluation.