A gum biopsy is a medical procedure in which a doctor removes a sample of tissue from your gums and sends it 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 include oral cancer and noncancerous mouth sores.
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 piece of suspicious tissue and a piece of nearby healthy tissue.
A pathologist will then compare the two samples.
The pathologist can determine if a cancerous area is forming from the cells on the suspicious gum tissue, if the cancer cells come from another deeper growth, or if they have spread to the gum from somewhere else in your body.
During an excisional gum biopsy, your doctor may remove the entire growth. How much they remove depends on the growth’s size and location.
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. This provides a sample for diagnosis. It also helps prevent the lesion from spreading or growing.
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 well if the lesion is large. In this procedure, a small needle connected to a syringe removes 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. Your doctor gathers 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 is used for an initial evaluation, or testing. 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.
If the test results show any suspicious growth or cancer, your doctor will likely do an incisional or percutaneous biopsy to confirm a diagnosis.
A gum biopsy tests for abnormal 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 subside
- 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 find gum cancer as early as possible. More time for treatments means less disfiguration or scarring from 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 during the test.
Some medications might affect the results of the gum biopsy. These include anticoagulants (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 does 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. It might be a special cream rubbed on the area. Then, local anesthesia will be injected to numb your gum. This may sting. Instead of an injection, your doctor may spray a painkiller onto the abnormal 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 when the biopsy is taken or the lesion is removed. 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 the tissue sample. 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 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’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 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, contact your doctor.
Prolonged bleeding and infection of the gums are two potentially serious risks. The good news is they're rare. 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 laboratory. A pathologist, a doctor who specializes in disease diagnosis, will examine the tissue under a microscope.
The pathologist will identify any signs of cancer or other abnormalities and make a report for your doctor.
An abnormal result from a gum biopsy could 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
If the results of your brush biopsy show precancerous or cancerous cells, you’ll need an incisional or percutaneous biopsy to confirm the diagnosis before beginning 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.