Frequently, patients are referred to an oral surgeon for evaluation of abnormal looking areas in their mouth, or an abnormality that is evident on an x-ray. Depending on the details, for example, area of the mouth, history and severity of the abnormality, size of the area, medications and health history, a biopsy of the abnormality may be recommended right away.
Most biopsies are performed with local anesthesia. The abnormal area can be removed in its entirety (an excisional biopsy), or if it is a larger area, a representative portion of the abnormal tissue can be removed (an incisional biopsy). Nearly all biopsied tissue should be processed and viewed microscopically to verify or establish a diagnosis. These services are done in an offsite pathology laboratory, and are billed for separately (to the patient). Once the diagnosis is established, the appropriate plan for definitive care and monitoring of the patient can be recommended.
Occasionally, the oral surgeon will recommend waiting on performing the biopsy. Sometimes, this is to allow time for therapeutic treatments to have effect, or for spontaneous improvement to have a chance to occur. Also, if a patient needs to discontinue a medication such as aspirin or Coumadin to prevent unwanted bleeding after the procedure, the procedure may need to be delayed.