A gum biopsy is a medical procedure in which a doctor removes a sample of tissue from your gums. The sample is then sent to a laboratory for analysis. A gum biopsy is also called a gingival biopsy because gingiva is another word for gums. The gingival tissue is the tissue that immediately surrounds and supports your teeth.
Doctors use a gum biopsy to diagnose causes of abnormal gum tissue. These causes can include oral cancer and noncancerous growths or lesions.
There are several different types of gum biopsies.
An incisional gum biopsy is the most common method of gum biopsy. Your doctor will remove a portion of suspicious tissue and examine it under a microscope.
A pathologist can determine if there are cancerous cells in the removed gum tissue. They can also verify the origin of the cells or if they have spread to the gum from somewhere else in your body.
During an excisional gum biopsy, your doctor may remove an entire growth or lesion.
This type of biopsy is normally used to take out a small lesion that is easy to reach. Your doctor will remove it, along with some of the nearby healthy tissue.
Percutaneous biopsies are procedures where a doctor inserts a biopsy needle through your skin. There are two different types: fine need biopsy and core needle biopsy.
A fine needle biopsy works best for lesions that are easy to see and feel. A core biopsy provides more tissue than a fine needle biopsy. This can be useful when more tissue is required to make the diagnosis.
A brush biopsy is a noninvasive procedure. Your doctor will gather tissue by forcefully rubbing a brush against the abnormal area of your gum.
A brush biopsy is often your doctor’s first step if your symptoms don’t call for an immediate, more invasive biopsy. It’s used for an initial evaluation.
If the test results show any suspicious cells, dysplasia, or cancer, your doctor will likely do an incisional or percutaneous biopsy to confirm a diagnosis.
A gum biopsy tests for abnormal or suspicious gum tissue. Your doctor may recommend it to help 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 go away
- changes in your gums that cause loose teeth or dentures
A gum biopsy can also be used along with imaging tests to reveal the stage of existing gum cancer. Imaging tests include X-rays, CT scans, and MRI scans.
The information from the gum biopsy, along with the findings of imaging tests, can help your doctor diagnose gum cancer as early as possible. Earlier diagnosis means less disfiguration or scarring from removal of tumors and a higher rate of survival.
Typically, you don’t have to do much to prepare for a gum biopsy.
You should tell your doctor if you take any prescription medications, over-the-counter drugs, or herbal supplements. Discuss how these should be used before and after the test.
Some medications might affect the results of the gum biopsy. These medications include blood thinners, medications that affect blood clotting, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. Your doctor might provide special instructions if you take any of these medications.
You may have to stop eating for a few hours before your gum biopsy.
A gum biopsy usually occurs as an outpatient procedure at a hospital or in your doctor’s office. A physician, dentist, or periodontist typically performs the biopsy. A periodontist is a dentist who specializes in diseases related to the gums and mouth tissue.
Prepping the area
First, your doctor will sterilize the gum tissue with something topical, such as a cream. Then, your doctor will inject local anesthesia to numb your gum. This may sting. Instead of an injection, your doctor may choose to spray a painkiller onto your gum tissue.
Your doctor might use a cheek retractor to make it easier to access your entire mouth. This tool also improves the lighting inside your mouth.
If the location of the lesion is hard to reach, you may receive general anesthesia. This will put you into a deep sleep for the whole procedure. That way, your doctor can move around your mouth and reach difficult areas without causing you any pain.
Incisional or excisional open biopsy
If you’re 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 during the procedure. The topical anesthesia should prevent you from feeling any pain.
Electrocauterization may be necessary to stop any bleeding. This procedure involves using 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, which means they dissolve naturally. If not, you'll need to return in about a week to have them removed.
Percutaneous fine needle biopsy
If you’re having a percutaneous fine needle biopsy, your doctor will insert a needle through the lesion on your gum and extract some cells. They may repeat the same technique at several different points in the affected area.
Percutaneous core needle biopsy
If you’re having a percutaneous core needle biopsy, your doctor will press 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 may hear a loud clicking or popping sound from the spring-loaded needle when the tissue sample is pulled out. There’s rarely much bleeding from the site during this type of biopsy. The area usually heals without needing stitches.
If you’re having a brush biopsy, you may not need topical or local anesthesia at the site. Your doctor will rub a brush strongly against the abnormal area of your gum. You may experience only minimal bleeding, discomfort, or pain during this procedure.
Since the technique is noninvasive, you won’t need stitches afterward.
After your gum biopsy, the numbness in your gums will gradually wear off. You can resume your normal activities and diet on the same day.
During your recovery, the biopsy site might be sore for a few days. Your doctor may ask you to avoid brushing around the site for one week. 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, contact your doctor.
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
The tissue sample taken during your gum biopsy goes to a pathology laboratory. A pathologist, or a doctor who specializes in tissue diagnosis, will examine the biopsy sample under a microscope.
The pathologist will identify any signs of cancer or other abnormalities and make a report for your doctor.
In addition to cancer, an abnormal result from a gum biopsy could show:
- 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 lesions or infections
If the results of your brush biopsy show precancerous or cancerous cells, you may need an excisional or percutaneous biopsy to confirm the diagnosis before starting treatment.
If your biopsy shows gum cancer, your doctor can choose a treatment plan based on the stage of the cancer. Early diagnosis of gum cancer can help make sure that you have the best chance of successful treatment.