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Current Topics in Oral Pathology
GUEST EDITORIAL
Current Topics in Oral Pathology
L
ynn W. Solomon, DDS, MS completed her dental degree, a residency in oral and maxillofacial pathology and a Master’s degree in Oral Sciences at the State University of New York at Buffalo School of Dental Medicine. After residency training, she was a faculty member at SUNY Buffalo in the Department of Oral Diagnostic Sciences for seven years. During her tenure at UB she served as the Director of Oral Medicine and most recently, as the Director of Oral Radiology. Dr. Solomon is a Fellow of the American Academy of Oral & Maxillofacial Pathology and a Diplomate of the American Board of Oral and Maxillofacial Pathology. Recently, she accepted a faculty position in the Department of Oral and Maxillofacial Pathology at Tufts University School of Dental Medicine and moved to Boston, MA in January 2007. In addition to teaching in the pre- and post-doctoral dental programs at Tufts, she practices in Tufts Oral Pathology Services (TOPS). Her research focus is on autoimmune responses to p63 proteins and immunoassay diagnostic techniques. She has published on a variety of topics in oral pathology. Lynn has been married to her husband David for 29 years; they are the parents of two adult daughters.
At the 2005 Alpha Omega convention I first met Dan Uditsky, the International Editor of the Alpha Omegan. When he discovered that I was an oral pathologist in academic dentistry, he suggested that we collaborate on an entire issue of the Alpha Omegan devoted to oral pathology. The opportunity was irresistible and, thanks to his encouragement and patience; and the generous contribution of manuscripts from my oral pathology, oral medicine and oral surgery colleagues, it is very exciting that this issue is now a reality. After graduation from dental school, oral pathology is all too often remembered as a difficult class where one had to memorize a plethora of confusing odontogenic cysts and tumors and view clinical photos of patients from with grotesquely swollen jaws distorted by ameloblastoma or Burkitt’s lymphoma. While oral pathology professors are generally regarded fondly, their work is sometimes regarded as esoteric and not really relevant to the average dentist. This issue demonstrates that far from being a static and unchanging dentistry backwater; recent developments in basic research, evidence-based
medicine, dental education models, demographics and pharmacology are changing oral pathology paradigms. Oral squamous cell carcinoma is of great concern to the dental profession because early stage disease is potentially curable. Unfortunately, most cases of oral carcinoma are diagnosed in late stages where treatment is associated with considerable morbidity and mortality. Drs. D’Silva and Ward explain current screening modalities, treatment, histologic indicators of survival and prognosis, and the continuing search for diagnostic and prognostic biomarkers in squamous cell carcinoma. Recent changes to the American Heart Association guidelines for prevention of infective endocarditis have greatly reduced the numbers of dental patients who need to premedicate before dental treatment. Drs. Esther Childers and Ron Brown explain the rationale for these changes and what they mean for your patients. Since its recognition as a dental specialty in 1950, the practice of oral pathology has been evolving. Traditionally oral pathologists have served on dental school faculties. With the increasing use of a business model in den-
GUEST EDITORIAL tal schools, there is less need to be affiliated with a dental school and more oral pathology services are becoming available outside of these institutions. Dr. Alan Gould shares his personal experiences and view of the future of oral pathology practice. Due to the aging a large segment of the population, the numbers of patients that present to dentists with symptoms of dry mouth will increase in the coming years. Dr. Susan Zunt is an expert on the evaluation of dry mouth patients and she shares the numerous causes of xerostomia and current diagnostic and management protocols for these challenging cases. An association of bisphosphonate pharmacotherapy and osteonecrosis of alveolar bone has been recently recognized. As many of our patients have been prescribed this medication, we need to understand their risks for development of bisphosphonate-associated osteonecrosis of the jaws (BONJ). Drs. Sook-Bin Woo and John Kalmar present a concise review of the pathogenesis of BONJ, as well as guidelines for evaluation and manage-
ment of patients to help them make informed treatment choices. One hoped for outcome from this issue, is that you will be encouraged to attend an oral pathology seminar at a dental convention or continuing education course. It is much more enjoyable to refresh your oral pathology knowledge when there is no 100-point test at the end of the lecture! In addition, I hope you will check the pathology atlas or textbook used in your office. If it was printed before 2000, buy an updated copy; use it often, and encourage the staff in your office to use it also. Downloadable, printable information about common oral conditions, which you can use for a patient resource, is available from the American Academy of Oral & Maxillofacial Pathology website http://www. aaomp.org/. In addition, the AAOMP maintains a member list. If you do not know an oral pathologist, I encourage you to find one in your area; he or she can be an invaluable resource for your practice and partner in your patient care. Dr. Lynn W. Solomon
Cover Art: A Glimpse into the Oral Pathology World (upper left) Digitally reformatted CT image shows the bony destruction caused by a central giant cell granuloma in the angle of the right mandible. Image courtesy of Dr. Nasser Said-Al-Naief, University of Alabama. (upper right) Immunohistochemistry using a monoclonal antibody to Ki-67 shows a high proliferative index in this rare case of plasmablastic lymphoma of the oral cavity. Image courtesy of Dr. Igor Rozenvald, Tufts-New England Medical Center. (middle right) This smooth, blue swelling of the hard palate of a young woman was diagnosed as a mucoepidermoid carcinoma. Image courtesy of IMMCO Diagnostics, Buffalo, NY. (lower right) A case of angina bullosa hemorrhagica. Image courtesy of Dr. Guy DiTursi, V. A. Western New York Health Care System. (lower left) Immunofluorescence microscopy provides a diagnosis of pemphigus vulgaris. Image courtesy of IMMCO Diagnostics, Buffalo, NY. (middle left) Invasive well-differentiated invasive squamous cell carcinoma. Image courtesy of Dr. Michael Kahn, Tufts University School of Dental Medicine.
Alpha Omegan • Volume 100 • Number 4
175
Current Topics in Oral Pathology
L
ynn W. Solomon, DDS, MS completed her dental degree, a residency in oral and maxillofacial pathology and a Master’s degree in Oral Sciences at the State University of New York at Buffalo School of Dental Medicine. After residency training, she was a faculty member at SUNY Buffalo in the Department of Oral Diagnostic Sciences for seven years. During her tenure at UB she served as the Director of Oral Medicine and most recently, as the Director of Oral Radiology. Dr. Solomon is a Fellow of the American Academy of Oral & Maxillofacial Pathology and a Diplomate of the American Board of Oral and Maxillofacial Pathology. Recently, she accepted a faculty position in the Department of Oral and Maxillofacial Pathology at Tufts University School of Dental Medicine and moved to Boston, MA in January 2007. In addition to teaching in the pre- and post-doctoral dental programs at Tufts, she practices in Tufts Oral Pathology Services (TOPS). Her research focus is on autoimmune responses to p63 proteins and immunoassay diagnostic techniques. She has published on a variety of topics in oral pathology. Lynn has been married to her husband David for 29 years; they are the parents of two adult daughters.
At the 2005 Alpha Omega convention I first met Dan Uditsky, the International Editor of the Alpha Omegan. When he discovered that I was an oral pathologist in academic dentistry, he suggested that we collaborate on an entire issue of the Alpha Omegan devoted to oral pathology. The opportunity was irresistible and, thanks to his encouragement and patience; and the generous contribution of manuscripts from my oral pathology, oral medicine and oral surgery colleagues, it is very exciting that this issue is now a reality. After graduation from dental school, oral pathology is all too often remembered as a difficult class where one had to memorize a plethora of confusing odontogenic cysts and tumors and view clinical photos of patients from with grotesquely swollen jaws distorted by ameloblastoma or Burkitt’s lymphoma. While oral pathology professors are generally regarded fondly, their work is sometimes regarded as esoteric and not really relevant to the average dentist. This issue demonstrates that far from being a static and unchanging dentistry backwater; recent developments in basic research, evidence-based
medicine, dental education models, demographics and pharmacology are changing oral pathology paradigms. Oral squamous cell carcinoma is of great concern to the dental profession because early stage disease is potentially curable. Unfortunately, most cases of oral carcinoma are diagnosed in late stages where treatment is associated with considerable morbidity and mortality. Drs. D’Silva and Ward explain current screening modalities, treatment, histologic indicators of survival and prognosis, and the continuing search for diagnostic and prognostic biomarkers in squamous cell carcinoma. Recent changes to the American Heart Association guidelines for prevention of infective endocarditis have greatly reduced the numbers of dental patients who need to premedicate before dental treatment. Drs. Esther Childers and Ron Brown explain the rationale for these changes and what they mean for your patients. Since its recognition as a dental specialty in 1950, the practice of oral pathology has been evolving. Traditionally oral pathologists have served on dental school faculties. With the increasing use of a business model in den-
GUEST EDITORIAL tal schools, there is less need to be affiliated with a dental school and more oral pathology services are becoming available outside of these institutions. Dr. Alan Gould shares his personal experiences and view of the future of oral pathology practice. Due to the aging a large segment of the population, the numbers of patients that present to dentists with symptoms of dry mouth will increase in the coming years. Dr. Susan Zunt is an expert on the evaluation of dry mouth patients and she shares the numerous causes of xerostomia and current diagnostic and management protocols for these challenging cases. An association of bisphosphonate pharmacotherapy and osteonecrosis of alveolar bone has been recently recognized. As many of our patients have been prescribed this medication, we need to understand their risks for development of bisphosphonate-associated osteonecrosis of the jaws (BONJ). Drs. Sook-Bin Woo and John Kalmar present a concise review of the pathogenesis of BONJ, as well as guidelines for evaluation and manage-
ment of patients to help them make informed treatment choices. One hoped for outcome from this issue, is that you will be encouraged to attend an oral pathology seminar at a dental convention or continuing education course. It is much more enjoyable to refresh your oral pathology knowledge when there is no 100-point test at the end of the lecture! In addition, I hope you will check the pathology atlas or textbook used in your office. If it was printed before 2000, buy an updated copy; use it often, and encourage the staff in your office to use it also. Downloadable, printable information about common oral conditions, which you can use for a patient resource, is available from the American Academy of Oral & Maxillofacial Pathology website http://www. aaomp.org/. In addition, the AAOMP maintains a member list. If you do not know an oral pathologist, I encourage you to find one in your area; he or she can be an invaluable resource for your practice and partner in your patient care. Dr. Lynn W. Solomon
Cover Art: A Glimpse into the Oral Pathology World (upper left) Digitally reformatted CT image shows the bony destruction caused by a central giant cell granuloma in the angle of the right mandible. Image courtesy of Dr. Nasser Said-Al-Naief, University of Alabama. (upper right) Immunohistochemistry using a monoclonal antibody to Ki-67 shows a high proliferative index in this rare case of plasmablastic lymphoma of the oral cavity. Image courtesy of Dr. Igor Rozenvald, Tufts-New England Medical Center. (middle right) This smooth, blue swelling of the hard palate of a young woman was diagnosed as a mucoepidermoid carcinoma. Image courtesy of IMMCO Diagnostics, Buffalo, NY. (lower right) A case of angina bullosa hemorrhagica. Image courtesy of Dr. Guy DiTursi, V. A. Western New York Health Care System. (lower left) Immunofluorescence microscopy provides a diagnosis of pemphigus vulgaris. Image courtesy of IMMCO Diagnostics, Buffalo, NY. (middle left) Invasive well-differentiated invasive squamous cell carcinoma. Image courtesy of Dr. Michael Kahn, Tufts University School of Dental Medicine.
Alpha Omegan • Volume 100 • Number 4
175