Expert: Mark Bornfeld DDS - 11/29/2006

Question
My dentist just discovered two small white bumps on the right side of my upper gums.  He scheduled a brush biopsy for next week.  The bumps are very small, appear only slightly raised, and are about 2 millimeters apart.  

I'm 26 and have smoked for about 6 years.  I know I should just be patient and wait for the test, but I really want to know exactly how paranoid I should be.  I'm specifically interested in what it might be *besides* cancer (doesn't look like leukoplakia), the efficacy of the brush biopsy, and the likelihood that what I've described would constitute early detection were the results to be positive.

Reards,
Paul

Answer
Dear Paul,

I don't necessarily think it would be productive to give you a list of about fifty different things that could manifest as white bumps-- some of the alternate diagnoses are innocent, and some are as profound as cancer, but my guessing will not give you an answer that will legitimately allay your fears. For example, a white patch could potentially be a slight hyperkeratosis (the intraoral equivalent of a callus on the skin), or it could be a secondary syphilitic mucous patch; it could be white sponge nevus, or it could be pemphigus vulgaris. Some of the potential diagnoses are good, some are bad, but none can be made in this forum that would be worth any more than your own imagination could think up.

I do think it's good that you're checking it out, and that your dentist is astute enough to bring it to your attention. However, I have my own opinion about the brush biopsy technique. While it can be viewed to have some value as a screening tool, it is not a sufficiently discriminating test in the event of atypical findings. A poorly harvested specimen could possibly yield a false negative for malignancy (i.e., could show a "benign" result in the presence of cancer), and a finding of cellular atypia is insufficient to take action, and would need to be followed by a more conventional biopsy technique anyway. An aggressively harvested specimen could also disrupt the appearance of the tissue, which might otherwise be helpful in identifying the lesion by a more skilled clinician.

I think a more prudent course of action is for the lesion to be studied by an oral surgeon or oral pathologist, and to let them decide if it is necessary to microscopically examine a tissue specimen. Most dentists are quite helpful in recognizing a lesion that needs further study, but have very limited experience in the actual diagnosis and treatment of oral cancer. It is best for a person with more experience in this area to have a look before any procedures are carried out on the affected tissue.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY