What Is a Gum Biopsy?
A gum biopsy is a medical procedure in which a tissue sample is extracted from your gums for laboratory analysis. The test is used to diagnose causes of abnormal tissue in your gums, which might be a result of oral cancer or noncancerous mouth sores.
Your gums also are known as gingiva. The gingival tissue is the tissue that immediately surrounds and supports your teeth. A gum biopsy is also called a gingival biopsy.
Types of Gum Biopsies
Your doctor may choose from several different procedures to perform your gum biopsy.
An incisional gum biopsy is the most common method of gum biopsy. In this procedure, your doctor will remove a piece of the suspicious tissue and another of the nearby healthy tissue.
By comparing the two samples, your doctor can determine if a cancerous area is forming from the cells on that gum tissue, if the cancer cells come from another deeper growth, or if they have spread to the gum from a different site elsewhere in your body.
During an excisional gum biopsy, your doctor may remove the entire growth—depending on the size and location of the lesion, or sore.
This type of biopsy is normally used to take out a small lesion that is in an easily reachable area of your mouth. Your doctor will remove the lesion, along with some of the nearby healthy tissue. This provides a sample for diagnosis, and helps prevent the lesion from spreading or growing.
There are two different types of percutaneous biopsies—or procedures where a doctor inserts a biopsy needle through your skin.
A fine needle biopsy may be used if the abnormal area is large. In this procedure, a small needle connected to a syringe extracts cells from the lesion. Your doctor may collect cells from different points on one lesion at the same time.
A core needle biopsy, or punch biopsy, uses a small circular blade to cut out a tissue sample. The blade is pushed down on your gum and your doctor pulls on the center of the area to withdraw a circular sample. The sample is freed from the tissue with small scissors or a scalpel. Your doctor may decide to use a punch biopsy depending on the location of the abnormal tissue and how easy it is to reach.
A brush biopsy is a noninvasive procedure used to gather tissue by forcefully rubbing a brush against the abnormal area of your gum. It is used for an initial evaluation, or testing.
A brush biopsy is often your doctor’s first step if your symptoms do not call for an immediate open or needle biopsy. If the results from this test show any suspicious growth or cancer, your doctor will likely do an incisional or percutaneous biopsy to confirm a diagnosis.
What Does a Gum Biopsy Test For?
A gum biopsy is done to examine and diagnose abnormal gum tissue.
Your doctor may recommend a gum biopsy to help him or her diagnose:
- a sore or lesion on your gum that lasts longer than two weeks
- a white or red patch on your gum
- ulcers on your gum
- swelling of your gum that does not subside
- changes in your gums that cause loose teeth or dentures
A gum biopsy can also be used to determine the stage or extent of a cancer that has been identified by imaging tests, such as X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans.
The information provided by a gum biopsy, together with the findings of imaging tests, can help your doctor to find gum cancer as early as possible. This gives you more time for treatments, resulting in less disfiguration or scarring from tumors and a higher rate of survival.
Preparation for a Gum Biopsy
Typically, you do not have to do much to prepare for a gum biopsy.
You should tell your doctor about any prescription medications, over-the-counter drugs, or herbal supplements you take. Discuss how these should be used before and during the test.
Your doctor may provide special instructions if you are taking medications that might affect the results of the gum biopsy. These include anti-coagulants (blood thinners); non-steroidal anti-inflammatory drugs (NSAIDs), like aspirin or ibuprofen; and any other medications that affect blood clotting.
You may have to stop eating for a few hours before your gum biopsy.
How a Gum Biopsy Is Done
A gum biopsy usually is done as an outpatient procedure at a hospital or in your doctor’s office.
A physician, dentist, or periodontist typically does the biopsy. A periodontist is a dentist who specializes in diseases related to the gums and mouth tissue.
First, the gum tissue to be examined will be sterilized with a topical preparation, or a special cream that is rubbed on the area. Then, an injection of local anesthesia will numb your gum. You may feel a stinging sensation while the anesthesia is being injected. Instead of an injection, your doctor may simply spray a painkiller onto the abnormal tissue.
A cheek retractor may be used to allow your doctor better access to your entire mouth. This tool also improves the lighting inside your mouth.
If the location of the lesion is in a hard-to-reach area of your gums, your doctor may use general anesthesia. This will put you into a deep sleep for the whole procedure. It will allow him or her to move around your mouth and reach difficult areas without causing you any pain.
Incisional Or Excisional Open Biopsy
If you are having an incisional or excisional open biopsy, your doctor will make a small incision through the skin. You may feel some pressure or minor discomfort when the biopsy is taken or the lesion is removed. However, because of the topical anesthesia, you should not feel any pain.
Electrocauterization may be needed to stop any bleeding. This procedure involves the use of an electric current or laser to seal blood vessels. In some cases, your doctor will use stitches to close the open area and speed your recovery. Sometimes, the stitches are absorbable—meaning they dissolve naturally. If not, they will need to be removed in about a week.
Percutaneous Fine Needle Biopsy
If you are having a percutaneous fine needle biopsy, your doctor will insert a needle through the lesion on your gum and extract the tissue sample. He or she may repeat the same technique at several different points in the affected area.
Percutaneous Core Needle Biopsy
If you are having a percutaneous core needle biopsy, your doctor will press the core needle, which is a small circular blade, onto the affected area. The needle cuts out a section of skin with a round border. Pulling on the center of the area, your doctor will extract a plug, or core, of cells.
You will hear a loud clicking or popping sound from the spring-loaded needle when the tissue sample is pulled out.
There is rarely much bleeding from the site during this type of biopsy. The area usually heals without needing stitches.
If you are having a brush biopsy, you may not need topical or local anesthesia at the site. First, your doctor will rub a brush strongly against the abnormal area of your gum.
The procedure is able to collect cancerous cells, since the links that bind these cells to each other and to the nearby normal cells are normally weak. You may experience only minimal bleeding, discomfort, or pain during this procedure.
Since the technique is noninvasive, you will not need stitches afterward.
Recovery from a Gum Biopsy
After your gum biopsy is completed, the numbness in your gums will gradually wear off. You will be able to resume your normal activities and diet on the same day.
During your recovery, the biopsy might be sore for a few days. Your doctor may ask you to avoid brushing around the biopsy site for one week. Also, if you received stitches, you may have to return to your doctor or dentist to have them removed.
If your gums bleed, become swollen, or remain sore for a long period of time, you should contact your doctor.
Risks of a Gum Biopsy
A gum biopsy can provide valuable information to your doctor, helping him or her find gum cancer at its earliest and most curable stage. In this way, the benefits of a gum biopsy often outweigh the risks.
Prolonged bleeding and infection of the gums are two potentially serious, but rare, risks. Contact your doctor if you experience:
- excessive bleeding at the biopsy site
- soreness or pain that lasts longer than a few days
- swelling of the gums
- fever or chills
Interpreting the Results of a Gum Biopsy
The tissue sample taken during your gum biopsy will be sent to a laboratory. A pathologist—a doctor who specializes in disease diagnosis—will examine the tissue.
Your sample will be analyzed under a microscope. The pathologist will identify any signs of cancer or other abnormalities and make a report for your doctor.
If your biopsy shows gum cancer, the information will help your doctor choose a treatment plan based on the stage of cancer. Early diagnosis of gum cancer can help make sure that you have the best chance of successful treatment and recovery.
If the results of your brush biopsy show precancerous or cancerous cells, you will need an incisional or percutaneous biopsy to confirm the diagnosis before beginning treatment.
An abnormal result from a gum biopsy could also be caused by:
- systemic amyloidosis: a condition where abnormal proteins, called amyloids, build up in your organs and spread to other parts of your body, including your gums
- thrombotic thrombocytopenic purpura (TTP): a rare, potentially fatal, blood clotting disorder that can cause bleeding of the gums
- benign mouth sores caused by infections and diseases that can be identified by analysis in a laboratory