Gum biopsy: what does it consist of?

A gum biopsy, also called a 'gingival biopsy', is a surgical procedure in which a small piece of gum tissue is removed to examine it in depth. The excised sample is sent to a pathology laboratory for analysis.

The gingival tissue is in charge of surrounding, supporting and protecting the dental elements. When you suffer from any disease or damage, the dentist may suggest a biopsy.

This exhaustive study of the tissues, in conjunction with other complementary methods such as X-rays, CT scans and MRIs, pallow to arrive at an accurate diagnosis of the problem that affects this region. Are you interested in knowing more about it?

Why should a gum biopsy be performed?

A dentist will recommend a gum biopsy to look for abnormal or suspicious tissue. This test makes it possible to diagnose with more precision those alterations in which the symptoms are not clear. Some of the situations in which it is recommended are the following:

  • Ulcers, sores or lesions on the gum that last more than two weeks.
  • Enlargement and swelling that does not go away.
  • White or red patches on the gum tissue.
  • Changes in the gums that cause tooth mobility or instability of dental prostheses.
  • As a stage control for pre-existing gum cancer. This is done along with imaging tests including X-rays, MRIs, and CT scans.

Gum biopsy is recommended when there are clinical manifestations of disease in the area.

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Gum biopsy: what types are there?

A gum biopsy is a medical procedure that allows a sample of gum tissue to be analyzed. However, depending on how the sample is made, there are different types. We share them in detail below.

Incisional biopsy

It is the most common and widely used type of gum biopsy. It consists of cutting and removing a portion of suspicious tissue to send it for analysis. The pathologist will examine it under a microscope to determine the type of cells present, their origin and if there are alterations compatible with cancer.

Excisional biopsy

In this case, the surgeon completely removes a lesion or tumor present in the gum tissue. It is often used to remove all small, easily accessible lesions. In turn, it is common for the surgery to remove part of the healthy tissue that surrounds the area. The excised material is also sent for analysis.

Percutaneous biopsy

Percutaneous biopsies are those in which the doctor uses the insertion of a needle through the skin for the extraction of the material. They can be done with thin or thick needles.

  • With fine needle: useful for easily accessible lesions that can be seen and palpated.
  • With thick needle: in those cases where access is compromised. It allows to take more quantity of tissue than the previous one.

Brush biopsy

This is a non-invasive method, as tissue harvesting is done by vigorously rubbing a brush against the gum lesion. The collected material and the brush are sent to the laboratory for initial analysis.

In general, it is useful for those cases in which the symptoms do not require a more invasive biopsy immediately. If the results show suspicious, atypical, or cancerous cells, confirmation of the diagnosis should be made with an incisional or percutaneous biopsy.

Preparation and how the gum biopsy is performed

A gum biopsy is a procedure that often happens on an outpatient basis in a hospital or office setting. It can be done by a doctor, a dentist, a periodontist, a stomatologist or a surgeon.

Before performing the intervention, it is necessary to prepare and schedule it. The doctor may give some instructions and prior care, suspend some commonly used medication, order complementary tests and indicate a fast of a few hours.

It is important for the patient to tell their family practitioner if they are using prescription, over-the-counter, or naturopathic medications, since the use of some active substances may interfere with the results of the biopsy.

How to perform the exam?

First, the doctor sterilizes the gum tissue with a topical antiseptic. Then, numb the area by injecting a local anesthetic or spraying a pain reliever. Sometimes it is necessary to use a cheek retractor to improve visibility and better access to the surgical area.

In cases of injuries located in areas of very difficult access or in patients with some special impairment, The intervention can be performed under general anesthesia, but it is not the most common.

When the patient no longer has sensitivity in the area, the tissue will be removed. Although there is no pain, you may feel tugging or pressure. As we already mentioned, there are different types of biopsies and the collection of material will be different for each one of them. Let's see in detail.

  • Incisional and excisional biopsy: a cut is made through the skin to remove the tissue. Sometimes it is necessary to stop bleeding with electrocautery, which is the use of lasers or electric current to seal the blood vessels. At the end it is sutured.
  • Percutaneous biopsy: If done with a fine needle, the doctor inserts the needle through the lesion and aspirates some cells. You can repeat it at different points in the affected area. If it is done with a thick needle, the professional presses the needle against the affected area and it cuts a section of the skin, taking a piece of the area that contains a nucleus or group of cells. They usually heal without problems and do not require stitches.
  • Brush biopsy: in this case, the local anesthetic is not necessary. The doctor rubs a brush against the injury. It can cause slight discomfort and bleeding, but since it is not invasive, it does not require suturing.

The sample taken, in all cases, is sent to the laboratory for analysis and it only remains to wait for the results.

There are several types of gum biopsy. The doctor will suggest one option or another, depending on the characteristics of the patient.

Recovery

After surgery, the numbness caused by the anesthesia will gradually go away. That same day you can resume eating and daily activities.

While the tissue heals, the biopsy site may feel sore and tender for a few more days. The doctor may indicate avoiding tooth brushing in that area to promote healing. If stitches were made, a week after surgery they are removed.

Gum biopsy risks

Complications after a gum biopsy are not very common. Still, there are two serious risks, such as gum tissue infection and prolonged bleeding. It is important for the patient to contact their doctor immediately if they have the following symptoms after surgery:

  • Severe pain that does not calm.
  • Excessive bleeding at the biopsy site.
  • Swelling of the gums
  • Fever and chills

What can an abnormal gum biopsy result tell me?

The pathologist who analyzes the sample identifies signs of cancer and other abnormalities present, and makes a report for the physician. When the results of the gum biopsy arrive, they help the professional, along with the other complementary methods, to reach a diagnosis.

The most common abnormal result of a biopsy is the presence of cancer. The doctor will be able to choose the most appropriate treatment according to the oncological stage. An early diagnosis allows you to act quickly and improve the survival rate.

As we have already clarified, the results of the presence of cancerous or precancerous cells obtained from a brush biopsy must be confirmed with an incisional or percutaneous biopsy. But in addition to cancer, there are other possible abnormal results.

  • Thrombotic thrombocytopenic purpura (TTP): it is a blood clotting disorder that can cause gum bleeding. It is rare and life threatening.
  • Systemic amyloidosis: is a condition in which amyloids (abnormal proteins) accumulate on the organs and spread to different parts of the body, such as the gums.
  • Non-cancerous mouth ulcers: in many cases, the root cause can be determined.
  • Benign mouth infections.

Find out: Risk factors for oral cancer

A timely gum biopsy improves prognosis

A biopsy is a quick, simple surgical procedure that can help detect a serious health problem, such as cancer. Planning the procedure with a trusted doctor and performing it early will prevent a dangerous injury from further progressing.

Going to the dentist regularly is essential. This allows to identify any abnormality in the mouth to act quickly. It also helps to avoid more unpleasant treatments or serious consequences for later life.