Australian Dental Journal 2010; 55:(1 Suppl): 9–13 doi: 10.1111/j.1834-7819.2010.01194.x Biopsy of the oral mucosa and use of histopathology services RM Logan,* AN Gossà *Oral Pathology, School of Dentistry, Faculty of Health Sciences, The University of Adelaide, South Australia.  Division of Surgical Pathology, SA Pathology, Adelaide, South Australia. àOral and Maxillofacial Surgery Unit, School of Dentistry, Faculty of Health Sciences, The University of Adelaide, South Australia. ABSTRACT Patients often present with intraoral pathology in the general dental practice setting. Therefore, it is important that dental practitioners are aware of how to deal with pathology when this occurs and have an understanding of investigative techniques that might assist in making a diagnosis. Biopsy and subsequent histological examination of the lesion is an important diagnostic tool. Even if dentists refer the patient to another practitioner for the biopsy, the referring practitioner still needs to be familiar with the procedure and results obtained so that the patient can be appropriately managed. This paper reviews clinical issues that may impact on biopsy procedures and the potential pitfalls and problems that may affect the histological assessment of tissue and therefore affect diagnosis. The medico-legal responsibilities of practitioners are also addressed. Keywords: Biopsy, oral mucosa, histopathology. INTRODUCTION Patients often present with intraoral pathology in the general dental practice setting. 1 Therefore, it is crucial that dental practitioners are aware of how to deal with pathology when it presents and have an understanding of investigative techniques that might assist in making a diagnosis. This is important irrespective of whether the dentist is the person actually undertaking the procedure or the investigation. If a referral is made to a specialist for biopsy, the referring practitioner still needs to be familiar with the procedures and results obtained so that the patient can be appropriately managed. The American Academy of Oral and Maxillofacial Pathol- ogy recommends that ‘‘all abnormal tissue be submitted promptly for microscopic evaluation and analysis’’. 2 It is generally accepted that in most instances, micro- scopic or histopathological examination of tissue is the gold standard for the diagnosis of many lesions that present in the oral cavity and surrounding regions. 2–5 Furthermore, in some types of pathology, histological examination is important not only in diagnosis but also to determine whether there is evidence of malignancy, provide information on the clinical behaviour of the lesion and, in some instances, give prognostic informa- tion 6,7 – all of which directly impact on patient management. Deciding whether a lesion needs to be biopsied is also an important clinical decision. For example, if there is uncertainty whether a lesion may be due to trauma, then the suspected irritant should be removed and the lesion reviewed in 7 to 10 days. If the lesion has not improved markedly then a biopsy is indicated. Despite the importance of the histological examina- tion of tissue, general dental practitioners do not regularly submit specimens for examination. 8 Suggested reasons for this include the clinician’s perceptions of training deficits and the risk of diagnostic error. 9 Also, the relative infrequency by which dentists encounter pathology compared to other oral / dental problems in general practice has been suggested to contribute to the lack of experience and confidence with respect to the management or further investigation of pathology. 9 Biopsy of mucosal lesions Franklin and Jones stated that adequate and appropri- ate collection of tissue is essential for accurate exam- ination, diagnosis and ultimately treatment. 10 There- fore, for dentists who undertake biopsy procedures, understanding what is adequate and appropriate is important. As discussed by Poh et al., an appropriate biopsy contains tissue that is representative of the lesion; this is dependent on three main factors, namely, ª 2010 Australian Dental Association 9 Australian Dental Journal The official journal of the Australian Dental Association