APPENDIX E
Typical Pathology Reports
Overview
A biopsy is a tissue sample removed from the patient that is examined by a pathologist to diagnose disease. The pathologist will process the tissue samples into very thin slices that can be examined under a microscope. Sometimes these slices are stained with various dyes to allow the pathologist to more easily differentiate the different cell types in the sample.
A biopsy is important because it is difficult to impossible to determine healthy or diseased tissue just by looking at it. Microscopic examination of the tissue sample allows the pathologist to see all the different cell types present and to accurately diagnose pathology.
In our case we are mainly looking for incomplete filling of the root canal space and necrotic debris left within the canal, osteonecrosis (dead bone), osteomyelitis (infected or inflamed bone), fibrous tissue, inflammatory cells, and cancer.
Results of the biopsy not only confirm our initial diagnosis but also assist us in deciding the need for any further treatment.
Conclusion
The preceding pathology reports accurately represent those from tissue samples from root canal-treated tooth extraction sites. All of these patients had been regularly seen by their dentist and no pathology was diagnosed. Yet, microscopic examination of the extracted teeth and tissue samples of the surrounding bone found definitive pathology.
Many of the root canal-treated teeth still contained dead and infected tissue. The jawbone around root canal-treated teeth as well as extraction sites where root canal-treated teeth were previously extracted showed pathology such as osteonecrosis, osteomyelitis, cysts, granulomas, bacterial
colonies, and disease-fighting immune cells. These focal areas of pathology are not normal.
The patients who had facial pain and were referred to neurologists left with no explanation of cause and a diagnosis of atypical facial pain of unknown origin. However, it is easy to see from the biopsy reports that the presence of localized foci of pathology should be included in the differential diagnosis of these facial pain patients.
Necrotic and infected pulp tissue left in root canal-treated teeth, bacteria within the root canal spaces and dentinal tubules, osteonecrotic/osteomyelitic bone with the presence of bacterial colonies, bone marrow edema, granulomas, and cysts are some of the pathological conditions that can have both a local and systemic effect. Microscopic tissue examination can detect the presence of disease that is routinely missed by typical dental exams.
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