PROSTHODONTICS - American College of Prosthodontists
PROSTHODONTICS - American College of Prosthodontists
PROSTHODONTICS - American College of Prosthodontists
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amenabletoexcisionthenitshouldalwaysberemoved.Alesionwithmoderate‐to‐severedysplasiashouldalwaysbeexcised.Biopsyshouldonlybeavoidedwhentheprocedurewouldsignificantlyendangerthehealthorsafety<strong>of</strong>thepatient.Length<strong>of</strong>observation<strong>of</strong>anundiagnosedlesionThefrequencyandlength<strong>of</strong>follow‐upisinfluencedbymanyfactorssoonlygeneralizedguidelinescanbeproposed(i.e.,neitherrigidpr<strong>of</strong>essionalguidelinesnorlegalstandards).However,thereissubstantialagreementintheliteraturethatanyundiagnosedlesionusuallyshouldbefollowedfor7‐14days,withorwithoutlocaltreatment.Ifthelesiongrows,developsalterationsincharacteristicordoesnotrespondtotherapythenbiopsyisclearlyindicatedIfthehistopathologicdiagnosisdoesnotyieldanysuspicion<strong>of</strong>malignantorpremalignantchangesbutclinicalconcernremains,thedentistandoralpathologistshouldconfertodecidewhetheritisappropriatetoperformanotherbiopsy,removetissuefromanotherarea,removealargerspecimenorsimplyobservethesiteovertime.Ifthelesionhasnotdisappearedbuthasnotchangedinappearanceorsurfacecharacteristicsthentheclinicianmustdecidewhethertobiopsyorifthelesionshouldbere‐evaluatedperiodically.Ifthedecisionismadetonotbiopsyalesionwithalowindex<strong>of</strong>clinicalsuspicionthenaprovisionaldiagnosisshouldbeformulatedandrecordedinthepatient’sdentalrecord.Withinformedconsent<strong>of</strong>thepatient,arrangementsshouldbemadetoperiodicallymonitorthelesionforchanges.Iftheclinicianisinexperiencedandunsure<strong>of</strong>thebestclinicalcoursethenreferraltoanoralandmaxill<strong>of</strong>acialpathologist,oralandmaxill<strong>of</strong>acialsurgeonorotherspecialistforasecondopinionisadvisable.Ingeneral,thepatientshouldbere‐examinedcarefullywithinonemonthandthenatthree,sixand12monthsaftertheinitialexamination.Ifsignificantchangesarenotedatany<strong>of</strong>theseexaminationsthenabiopsyshouldbearrangedimmediately.Afteroneyear,mostunchangedlesionscanbemonitoredeverysixmonths,andaftertwoyears,mostcanbemonitoredsemiannuallyorannuallyaspart<strong>of</strong>thepatient’sroutinedentalexamination.Thepatientshouldbeadvisedthattheycontactthedental<strong>of</strong>ficeifanychangesarenotedinthearea<strong>of</strong>thelesionbeforethenextscheduledvisit.ReferencesAlexanderRE,WrightJM,ThiebaudS.Evaluating,documentingandfollowinguporalpathologicalconditions.JADA2001;132:329‐35KingRC,McGuffHS.Biopsy:alifesavingmeasure.TexDentJ1996;113:45.NevilleBW,DammDD,AllenCM,BouquotJE.OralandMaxill<strong>of</strong>acialPathology,2ndedition,W.B.SaundersCo.,2002.PetersonLG,EllisE,HuppJR,TuckerMR,eds:Contemporaryoralandmaxill<strong>of</strong>acialsurgery.3rded.St.Louis:Mosby:1998:512‐32.WrightJM.Areviewandupdate<strong>of</strong>oralprecancerouslesions.TexDentJ1998;115:15‐9. 482010 CDEL Re-recognition <strong>of</strong> the Specialty Report 232 <strong>of</strong> 279
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