It's a pleasure to talk to you today. I'm Dr.

Cristiane Squarize, a oral and

maxilofacial pathologist, principal investigator, and faculty at the University of
Michigan School of Dentistry. Today, I will talk to you about a specialty of oral
and maxilofacial pathology, also known as oral pathology. So, what is oral
pathology and what does oral pathologist do? A oral and maxilofacial pathology is
one of the nine dental specialties in the US. This specialty is internationally
recognized. A oral pathologist is a professional that works on the diagnosis of
diseases. He or she performs the analysis of the biopsy to obtain a more definitive
diagnosis. Note that a biopsy is a procedure to remove a sample of tissue from the
body to be analyzed in a laboratory. The oral pathologist participates in the
diagnosis alongside with the radiologists, oral surgeons, oral medicine
practitioners, and oral health care professionals. As you can appreciate, oral
pathology is an interdisciplinary and interprofessional specialty. In addition, the
oral pathologist communicates the findings and diagnosis to dentists and health
care professionals. The result of his or her work will impact treatment decisions
and choices as well as referral. Why do I say that? How can a treatment be
determined if a doctor doesn't know what the patient has? This concept and
relationship between diagnosis and treatment was well established by Dr. Charcot in
the early 1800s quote, "To determine how to treat a disease, one must learn how to
recognize it. The diagnosis is the best trump in the scheme of treatment."
Furthermore, if the diseases and their causes are determined, steps to prevent
disease may be applied in the clinic. For many conditions, the molecular changes
and causes has not been determined yet. Therefore, a lot still need to be
understood. The oral pathology specialty is an excellent fit for doctors who are
also considering working in the academia and basic and translational research. What
are some examples of diseases in the oral cavity? Interesting, the mouth is an
important organ with many functions. It is also prompt to several medical and
dental disorders because it is made of different tissues including bone, salivary
gland, muscles, fat, mucosa. These tissues can be a source of diseases. The most
common disease in dental is [inaudible] caries. Advanced stage caries then can lead
to both death and the development of periapical infections, which are infections at
the tip of the tooth. If left untreated, these conditions of the cavitated tooth
can even lead to death. Caries can be very painful and even cause infection inside
of the bone. You can appreciate bone destruction that is identified by the red
circle on the x-ray picture on your right. Other type of cysts can occur in the
oral cavity. Some common ones can be found in children, such as the eruption cyst.
Another example is shown on the right. It is the dentigerous cyst. Tooth structures
can originate tumor-like malformations. Tumor from teeth? That's right. Odontomas
are the most common odontogenic tumors. An example is in the x-ray image on the
left. There are two types of odontomas: the compound and the complex forms. The
compound odontoma is well-organized, which means that the tooth-like structures can
be identified. But the complex one, the tooth is poorly-organized mess. Another
example of odontogenic tumors is the ameloblastoma. Odontogenic tumors are a growth
composed of cells and tissues that originate teeth. The ameloblastoma is the most
common odontogenic tumor after the odontoma. Clinically, it is locally aggressive
and invasive, cause bone destruction. Although it is a benign and a slow-growing
tumor and painless, expansion of the jaw is seen in both photograph and x-ray. If
left untreated, it can grow even to larger size. Where are the lesions and tumors
that occur in the oral cavity and surrounding structures? Well, where are your
salivary glands? The salivary glands are found in and around the mouth and the
cheeks, and they can also give rise to tumors. Here are two examples, one located
on a major salivary gland, the parotid, and another inside of the oral cavity, more
specifically, in the posterior palate. Although some of the lesions that you saw
until now were cancer, most of the lesions inside of the mouth are reactive
lesions. That means that they developed in response of local trauma and sometimes
repetitive and chronic injury or inflammation. They can easily be treated, or in
some instances, they may resolve on their own. The picture is an example of a
reactive lesion. It is a mucocele, also known as mucous or saliva retention cyst,
which usually appears after trauma from biting the lower lip. Mucocele is reported
in patients of all ages, but most common in children and young adults. The oral
squamous cell carcinoma is the most common malignant tumor found in the head and
neck area. Common names are oral cancer, mouth cancer, tongue cancer, tonsil
cancer, and throat cancer. It is the most common malignant cancer in the oral
cavity and is among the ten most common cancers worldwide. This includes cancers
that occur in the mouth itself and on the very back of the mouth, a area called
oral pharynx. For more than a decade, there has been an increase in the occurrence
of oral and oropharyngeal cancers. The picture in the right is an example of
advanced stage oral cancer. Early stage oral cancer and even precancerous lesions
can be identified during routine oral examination in the dental office. Prevention
is the best approach to stop cancer. Dentists and dental professionals can also
provide information and work with patients to prevent behaviors, exposures, and
other factors that may increase the risk of cancer. Oral cancer takes more lives
than cancers we routinely hear about. It's more deadly than cervical, breast,
prostate, Hodgkin's lymphoma, skin, and many other cancers. Oral cancers is mostly
associated with the use of tobacco and its effects might be potentialized by
alcohol consumption. The virus known as HPV also plays a role in the head and neck
cancer. Do you know anyone who had head and neck cancer? Here are some well-known
people and celebrities that had oral cancer. Other examples of stars that had oral
cancer are listed at the Oral Cancer Foundation website. For more information in
the involvement of HPV in the development process of oral cancer and oropharyngeal
cancer, please take a look at the link associated to this presentation. We made
available a link to a publication from my laboratory which reviews the HPV
infection role in head and neck cancer. Information available in recent studies and
by the CDC, which is the Centers for Disease Control and Prevention in the US, show
that nearly 80 million people, about one in four, are currently infected in the
United States. About 14 million people including teen becomes infected with HPV
every year. Prevention remains the best strategy to avoid HPV infection and,
consequently, HPV-associated cancers. Recent association of HPV with a sub-
population of head and neck cancers open a potential to use the HPV vaccine as a
preventive therapy. It is well-documented that HPV vaccine protects against HPV
infection. Looking to the future in cancer management, we see the development of
novel technologies and therapies, like gene editing with CRISPR and immunotherapy,
that have been showing promising results in other cancers and diseases. I'm also
excited about recent studies coming from the genetic field. The epigenome, along
with other functions, links the expression of genes with the environment that we
live in. Therefore, novel studies in this area may help us to better understand how
cancer cells respond to the tumor microenvironment as well as chemotherapy and
radiotherapy.