Laboratory Investigations

in Dentistry
• Laboratory studies are an extension of physical
examination in which tissue, blood, urine or
other specimens are obtained from patients and
subjected to microscopic, biochemical,
microbiological or immunological
examination.
• Information obtained from these investigations
help us in identifying the nature of the disease.
• Patient history and clinical examination usually
reveal most of, but not all of clinically relevant
data.
• The provisional diagnosis can be made on the
basis of case history and clinical examination
but for definitive diagnosis, laboratory
investigations are required.
• Lab investigations supplement rather than
replace other methods for gathering
information.
• It is a known fact that with the help of lab

Applications
• Confirming or rejecting clinical diagnosis.
• Providing suitable guidelines in patient
management.
• Providing prognostic information of the
diseases under consideration.
• Detecting diseases through case-finding
screening methods.
• Establishing normal baseline values before
treatment
• Monitoring follow up therapy.
 Classifications
Based on where investigation is done:
22
Chairside Investigations Laboratory Investigations
Acts as a precursor to laboratory Significantly higher sensitivity and
investigations specificity
Ex: Ex:
Toluidine blue staining for grading Glycated Haemoglobin estimation,
dysplasia, Peripheral smear histology
Electric Pulp testing for tooth
vitality,
 Classifications
Based on specificity/sensitivity:

Screening Tests Diagnostic

Tests
An ideal screening test is 100% An ideal diagnostic test is 100%
sensitive (able to correctly identify specific (able of correctly identify
those with the disease (true positive those without the disease (true
rate)) negative rate)

Useful in a large sample size at risk; Useful in symptomatic individuals to

typically cheaper establish diagnosis or asymptomatic
individuals with positive screening
test; expensive
Ex: Ex:
blood glucose estimation for Glycated Haemoglobin estimation,
screening diabetes, OGTT,
Haematocrit values for anaemia, Peripheral smear histology

Classifications
Based on Hospital Lab Services:

Haematology Urinalysis
Biochemistr Biochemistry
y

Immunology Cytopathology

Histopathology
 Classifications
Based on frequency of dental use (Sonis, Fazio & Fang):

Frequently used:
Occasionally done: Rarely ordered:
• CBC- Hb, Hct, Absolute • Enzyme testing
• Tests for disturbance of • Bilirubin Estimation
and differential WBC
bone – Ca, P, ALP
• Bleeding studies – • Creatinine Estimation
• ESR
BT,CT, PT, aPTT • Acid Phosphatase
• Urinalysis • BUN
• Peripheral Blood Smear
• Screening Test for
• Random Blood Glucose
Syphilis
 Significance of Blood Investigation
• Blood investigation helps in diagnosing
– Leukopenia
– Thrombocytopenia
– Myeloma
– Anemia
• *Iron deficiency
• *Aplastic anemia
• *Sickle cell anemia
– Thalassemia
– Acute and Chronic leukemia
– Liver disease
– Myxedema

Collection of Blood Sample

Capillary Blood Specimens:
The specimen is obtained by
pricking the patient`s finger.

Venous Blood Specimen:

Most commonly used method.
Venipuncture is usually performed
in ANTECUBITAL vein.
-
 Types of Hematological
Investigations
• WBC count
• Differential Leukocyte count
Complete Blood
• RBC count Count
• Hemoglobin
• Hematocrit
• Erythrocytes indices
• Platelet Count
• Bleeding time
• Capillary Fragility Test
• Clotting Time
 Complete Blood Count (CBC)
• Calculation of the cellular elements of blood.
• It is one of the most commonly ordered blood tests.
What are the components of the complete blood count (CBC)?

• White blood cell count (WBC or leukocyte count)

WBC • WBC differential count

• Red blood cell count (RBC or erythrocyte count)

• Hematocrit (Hct)
• Hemoglobin (Hbg)
RBC • Mean corpuscular volume (MCV)
• Mean corpuscular hemoglobin (MCH)
• Mean corpuscular hemoglobin concentration
(MCHC)

PLATELET • Platelet count

 WBC/Leukocyte Count
• Number of white blood cells in a volume of blood.
• Normal range of WBC ≅ 4,500 - 10,000 cells/mm3 of blood.

Specific causes of Specific causes of

Leukopenia:
Leukocytosis: – Aplastic anaemia
– Infection- Acute and – Influenza, measles and
Chronic Respiratory tract infection
– Early Leukaemia
– Leukemia – Depression of Bone marrow
– Polycythemia – Drug and chemical toxicity
– Trauma – Shock

– Exercise , Stress and

fear
 Differential Count WBC
• White blood cells are comprised of several different types of
cells that are differentiated, or distinguished, based on their
size and shape.

WBC

Granulocytes Agranulocytes

Neutrophils Eosinophils Basophils Lymphocytes Monocytes

 Normal values
• Granulocytes (or polymorphonuclears)
– Neutrophils: 43-77% (3000-7000)
– Eosinophils: 0-4% (50-200)
– Basophils: 0-2% (0-100)

• Agranulocytes (or mononuclear)

– Lymphocytes: 17-47% (1000-3500)
– Monocytes: 2-9% (100-600)
 CLINICAL SIGNIFICANCE
Neutrophils Eosinophils Basophils

INCREASES in:• INCREASES in: • INCREASES in:

– –
Parasitic infections Chronic leukemia
Inflammatory – Hypersensitivity/
disease Allergic responses – Myelofibrosis
– Polycythemia
Stress – Scarlet Fever
• DECREASES in:
Exercise • DECREASES in:
– Acute Infection
Pregnancy – Immune defect
– Severe injury
– Acute stress
Acute Infection – Typhoid Fever
Excitement – Aplastic Anaemia
DECREASES in:
 CLINICAL SIGNIFICANCE
• Lymphocytes • Monocytes
• INCREASES in: • INCREASES in:
– Lymphocytic Leukemia– Monocytic leukemia
– Mumps – Hodgkin disease
– Whooping Cough – Malaria – Kala-azar
– Chronic Infection – Infectious
• DECREASES in: mononucleosis
– Aplastic Anaemia • DECREASES in:
– Aplastic Anemia
 Oral and Dental Considerations
• Most common sign of neutropenia is ulceration of oral
mucosa.
• Ulcers lack surrounding inflammation and are characterized
by necrosis.
• Advanced periodontal disease, pericoronitis, pulpal
infections.
• Most common sign of leukemia- cervical lymphadenopathy
• Others-pallor of the mucosa, petechiae, echymosis, gingival
bleeding, oral ulcers, oral infections (candidiasis)
 Red Blood Cell (RBC) Count
• Number of red blood cells in a volume of
blood.
• Normal range: 4.2 - 5.9 million
cells/microliters
• This can also be referred to as the Erythrocyte
count.
• It can be expressed in international units:
4.2 to 5.9 x 1012 cells per liter.
 INCREASE in RBC Count
• An increase in red blood cell mass is known as
Polycythemia.
• PV is a chronic myeloproliferative disease
characterized by a predominant proliferation of
the erythroid cell line.
• Oral manifestations:
– Purplish red discoloration of oral mucosa, gingivae
and tongue,
– Gingivae are markedly swollen and bleed
spontaneously but not ulcerated
 DECREASE in RBC Count
• Massive RBC loss, such as acute hemorrhage
• Abnormal destruction of red blood cells
• Lack of substances needed for RBC production
• Chemotherapy or radiation side effects from
treatment of bone marrow malignancies such
as leukemia can result in bone marrow
suppression.
 HEMOGLOBLIN
• Hemoglobin is the protein molecule within red
blood cells that carries oxygen and gives
blood its red color.
• Normal range
– 13-18 grams per dl for men and
– 12-16 grams per dl for women
• Low hemoglobin count can be due to blood
loss.
• Diseases and conditions that cause the body to
destroy red blood cells faster than they can be
made:
– Enlarged spleen (splenomegaly)
– Sickle cell anemia
– Thalassemia
– Vasculitis
 Hematocrit (Hct)
• It is a measure of volume percent of packed red blood
cells to that of whole blood.
• Normal results :
– Male: 40.7 - 50.3%
– Female: 36.1 - 44.3%
 Erythrocytes Indices
• To evaluate the nature of Anaemia, assistance is
obtained by calculating standard indices relating to
the size of RBCs.
• By measuring these indices we can classify anaemia
as Microcytic, Macrocytic And Normocytic and
Hypochromic and Normochromic.
 Mean Corpuscular Haemoglobin
(MCH)
• The Haemoglobin content of erythrocyte is
referred to as the Mean Corpuscular
Haemoglobin.
• MCH is expressed in picogram of haemoglobin
per cell.
 Mean Corpuscular Haemoglobin
Concentration (MCHC)
• The concentration of Haemoglobin in the
erythrocyte is referred to as the Mean
Corpuscular Haemoglobin Concentration.
• MCHC is expressed in picogram of
haemoglobin per cell.
 Mean Corpuscular Volume (MCV)
• The average red cell volume is referred to as
the Mean Corpuscular Volume (MCV).
• It is expressed in cubic microns per cell.
Different types of Anaemia and
Indices
crocytic & Hypochromic
mia (decreased MCV and
• The common causes are:
– MCH)
Iron deficiency anemia
– Anemia of chronic disease
– Thalassemia
– Sideroblastic anemia
 Oral Manifestations
• Angular cheilitis (58%),
• Glossitis with different degrees of atrophy of
fungiform and filliform papillae (42%),
• Pale oral mucosa
• Oral candidiasis
• Recurrent aphthous stomatitis
• Erythematous mucositis
• Burning mouth for months –year.
 Macrocytic Anemia
(increased MCV and MCH)
• The common causes are:
– Folate or Vit B12 deficiency anemia
– Liver disease
– Hemolytic or Aplastic anemias
– Hypothyroidism
– Excessive alcohol intake
– Myelodysplastic syndrome
 Oral Manifestations
• Patients with pernicious anemia may have
complaints of:
– Painful glossitis and glossopyrosis-early symptoms
– Dysphagia
– Burning sensation in the tongue, lips, buccal
mucosa, and other mucosal sites.
– The tongue and mucosa may be smooth or patchy
areas of erythema.
– And loss of taste sensation
 Normocytic And Normochromic Anemia
(normal MCV, MCH and MCHC)
• The common causes are:
– Anemia of chronic disease
– Acute blood loss
– Hemolytic anemia, such as autoimmune hemolytic
anemia, hereditary spherocytosis, or
nonspherocytic congenital hemolytic anemia (i.e.
glucose-6-phosphate dehydrogenase (G6PD)
deficiency)
– Anemia of renal diseases.
 Oral Manifestations
• Pallor of oral mucosa especially evident in soft
palate, tongue, sublingual tissues
• Paresthesia of mucosa
• For those with chronic conditions, hyperplastic
marrow spaces in the mandible, maxilla, and
facial bones
 PLATELET/THROMBOCYTE
COUNT
• The number of platelets in a specified volume of
blood.
• Platelets play a vital role in Hemostasis.
– Normal range (Adult) =150,000 to 400,000/ microliters of
blood. (150 to 400 x 109/ L)
– Normal range(Children) =150,000-450,000 /mikroliters of
blood. (150-450 x 109/L)
 Interpretation of Platelet count

THROMBOCYTOSIS:
Post operative phase
Pregnancy
Post partum phase Haemolytic THROMBOCYTOPENIA:
Anemia Trauma Acute leukemia
Polycythemia vera Idiopathic thrombocytopenic purpura
Chronic myelocytic leukemia Aplastic anemia
Effect of chemotherapy
Hypersplenism
 Erythrocyte Sedimentation Rate
(ESR)
• It is the measure of the rate at which RBCs sediments in a
period of one hour.
• Also called as Sedimentation Rate or Westergren ESR
• It is a non-specific measure of inflammation.
• Also helpful in following progress of some chronic infections
(Osteomyelitis)

Normal ESR
Male: 0-15 mm per hr
Female: 0- 20 mm per hr
 Interpretation
of ESR

ESR decreased: Congestive

ESR increased: cardiac failure Polycythemia
Tuberculosis Severe dehydration like cholera
Osteomyelitis
Rheumatic fever
Myocardial infarction
Rheumatoid arthritis Physiologic condition where
Hodgkin's disease ESR is increased:
Leukemia Pregnancy: After intake of full
meal
 Bleeding Time

It measures the time required for hemostatic plug to form.

Lack of any clotting factor or platelet abnormalities will prolong

the bleeding time.

It is used to screen disorders of platelet function and

thrombocytopenia

Normal Bleeding Time: 2 - 6 minutes

 Interpretation of bleeding time

An Abnormal Bleeding time- It is usually the result of

abnormalities in the structure / abilities of capillaries to contract
or abnormalities in the number (Thrombocytopenia) and
functional integrity of platelets.

Prolonged in:
Thrombocytopenia
Acute leukemia
Aplastic anemia
Liver diseases
Von-Willebrand’s disease
 Capillary Fragility Test

• It is the test of the ability of superficial capillaries of the skin

of the forearm and hands to withstand an increased intra-luminal
pressure and a certain degree of hypoxia.

It is done by occluding the upper veins of the upper arm with

a blood pressure cuff for five minutes.
Also known as Tourniquet Test
 Capillary Fragility Test

• Indication:
• 1. Bleeding abnormalities
• 2. Petechiae in oral cavity
• 3. Scurvy

• Positive result: unequivocal petechiae seen

distal to cuff.(15-20/2.5cm2)
• Negative result: If only 1 or 2 petechiae seen
distal to cuff.
 Clotting Time

Time required for coagulation to occur in a sample of whole

blood outside the body is known as Clotting Time.
Normal time- 3 to 7 minutes
Method are:
• Capillary tube method
• Le and white’s test tube method
 Interpretation of Clotting
time
An abnormal Clotting time- It is usually prolonged in
diseases affecting stages of coagulation.

It is also increased in: Cirrhosis

Hemophilia A and B
Factor XI deficiency,
Hypofibringenemia and
Heparin & Dicumarol therapy.
 HEMATOLOGICAL
INVESTIGATIONS
(not so frequent in dentistry)

• Prothrombin Time
• Partial Thromboplastin Time
• INR
 PROTHROMBIN TIME

It is the time in seconds that is required for development of a

clot in citrated or oxalated plasma, where known amount of
tissue thromboplastin and calcium is added.

It is used to check the extrinsic pathway factor (F7) and the

common pathway (5, 10 , prothrombin and fibrinogen).

Normal range: 11 to 15 seconds

Prolonged time (>3 times) indicates a hemorrhagic tendency.

It gets prolonged when plasma level of any factor is below
10% of its normal value
Prothrombin Time (PT):

Increased PT
Disseminated Intravascular Coagulation
Patients on Warfarin Therapy
Vit K deficiency
Early & End stage Liver failure

5
 PARTIAL THROMBOPLASTIN
TIME
It is the time in seconds that is required for a clot to form in a
sample of oxalated plasma, to which a partial thromboplastin
reagent and calcium is added.

It is used to check the intrinsic system (8, 9, 11, 12) and the
common pathways (5, 10, prothrombin and fibrinogen).

Normal range: 25-35 seconds

If PTT is prolonged it indicates deficiency of factor 8 or 10

 INR:
INTERNATIONAL NORMALIZED RATIO

The International Normalised Ratio (INR) is a laboratory

measurement of how long it takes blood to form a clot. It is used
to determine the effects of oral anticoagulants on the clotting
system.

It is the ratio of Patient’s Prothrombin Time to that of

normal Prothrombin time.
INR= Patient`s PT
Normal PT
 ❑It should be noted that INR is used to monitor Anti coagulant
therapy & NOT be used as coagulation screening test
❑INR values of 5.0 or greater indicate a serious
risk of spontaneous bleeding episodes.
❑ NORMAL RANGE: 0.8-1.2 (No anticoagulant therapy)
2-3 (On anticoagulant therapy)

• Infiltration anesthesia , scaling and

INR <3
root planning

INR <2 • Block anesthesia , minor surgery , extraction

INR <1.5 • Major surgery

Biochemistry
 Serum Iron and Total Iron Binding Capacity
(TIBC)
• Iron deficiency is usually detected on the basis
of the amount of iron bound to transferrin in
the plasma (serum iron) and the total amount
of iron that can be bound to the plasma
transferrin in vitro.
• Normal values
– Serum iron – 80-180 µg/dl
– TIBC – 250 – 370 µg/dl
 Oral Glucose Tolerance Test (OGTT):
• High values are seen in Diabetes mellitus,
Cushing’s disease, pheochromocytoma, in
patients taking corticosteroids.
• Low values seen in insulin secreting tumors,
Addison’s, Pituitary hypofunction.
• Used for the definitive diagnosis of DM and
for distinguishing diabetes from other causes
of hyperglycemia like hyperthyroidism.
• Should be performed on only healthy
 ambulatory patients who are not under any

Blood Glucose

Glycated Fasting Plasma Glucose Oral Glucose

Haemoglobin (FPG) Tolerance
(HbA1c) Test (OGTT)

Normal <5.7% <100 mg/dl <140 mg/dl

Prediabet 5.7% to 6.4% 100 mg/dl to 125 mg/dl 140 mg/dl to 199 mg/dl
es

Diabetes 6.5% or higher 126 mg/dl or higher 200 mg/dl or higher

 Serum Chemistry
Glycated Haemoglobin(HbA1c):
• Hb becomes glycated by ketoamine reactions
between glucose and other sugars.
• Once Hb is glycated, it remains that way for a
prolonged period (2-3 months).
• Hence it provides a definitive value of blood
sugar control of 2-3 month duration.
• The HbA1c fraction is abnormally elevated in
diabetic patients with chronic hyperglycaemia.
• It is considered to be a better indicator for
 Oral Manifestations of DM
• Mucosal conditions include
– oral dysesthesia, including burning mouth,
– Altered wound healing,
– Increased incidence of infection, candidal infections
(particularly acute pseudomembranous candidiasis
of the tongue, buccal mucosa, and gingiva).
• Xerostomia and bilateral generalized salivary
gland enlargement or sialadenitis (especially in
the parotid glands) can occur and both are
often related to poor glycemic control.
 Serum Chemistry
Serum Calcium, Phosphorus:
• Indicated on suspicion of Paget’s disease,
fibrous dysplasia, primary and secondary
hyperparathyroidism, osteoporosis, multiple
myeloma or osteosarcoma.
• The conc. of Serum Ca varies inversely with
serum P
– Normal level Serum Ca – 9.2-11 mg/dl
– Normal level Serum P – 3- 4.5 mg/dl
• At levels less than 7 mg/dl Serum Ca, signs of
 tetany (neuromuscular excitability) may appear.
Serum Chemistry (Infrequently
used)
Serum Alkaline Phosphatase: (ALP)

• ALP produced in small amounts in the liver but

most notably in osteoblasts
• Normal values:
ADULT CHILD

King Armstrong 3-13 15-30

Units

Bodansky Units 1-4 5-14

International 30-110
Units
(IU/l)
 Serum Chemistry (Infrequently
used)
Serum Alkaline Phosphatase: (ALP)

High values Low values

Obstructive liver disease Hypophosphatasia
Rickets Aplastic/Pernicious anaemia
Osteomalacia Osteoporosis
Paget’s disease of bone Hypothyroidism
Hyperparathyroidism
Sarcoidosis Chronic Myeloid Leukaemia
Lymphoma Wilson’s Disease
 Serum Chemistry
Serum Alkaline Phosphatase: (ALP)
• This test is very useful for diagnosing biliary
obstruction.
• Even in mild cases of obstructive disease, this
enzyme is elevated.
• It is not very useful for diagnosing cirrhosis.
• If a patient has bone disease, this test may be
highly inaccurate, as ALP is also found in bone
tissue.
 Serum Chemistry (Infrequently used)
Total Protein & Albumin/Globulin Ratio:
• These proteins are important in coagulation,
transport a variety of hormones, act as buffer
systems and help maintain osmotic pressure
• Normal range:
– Total protein – 6 – 8.3 g/dL
– A/G ratio - 1.2 – 2.0
• Elevation: multiple myeloma, systemic lupus
erythematosus, amyloidosis, collagen diseases etc.
• Serum protein electrophoresis: albumins,fibrinogen,
globulins (alpha1, alpha2, beta, gamma),
agammaglobulinemias
 Serum Cholesterol, Triglycerides
and Lipoprotein Electrophoresis
• Normal value:
• Total cholestrol :
– 75-169 mg/dL for those age 20 and younger
– 100-199 mg/dL for those over age 21
• HDL: >40 mg/dl
• LDL: <130 mg/dl
• TRIGLYCERIDES: <150 mg/dl
 Liver Function Tests (LFT)
• Helpful to detect the abnormalities and extent
of liver damage.
• LFT assays are frequently more sensitive than
clinical signs and symptoms.
• Typically the LFT comprises of:
– Total protein
– Albumin and globulin
– (Prothrombin Time)
– Transaminases – AST & ALT
– Alkaline phosphatase
– Bilirubin, usually fractionated

• Alanine Aminotransferase (ALT)/SGPT

• The test is primarily used
– to diagnose liver disease,
– to monitor the course of treatment for hepatitis,
– active post-necrotic cirrhosis, and
– the effect of drug therapy.
• Normal value: 8-45 U/liter
• ALT is the most sensitive marker for liver cell
damage.
• Aspartate Aminotransferase (AST)/SGOP:
• It may be elevated in conditions such as
myocardial infarct and muscle disease
• Normal value:<25 U/L
• Gamma glutamyl transpeptidase:
• Normal value:9-48 U/L
• Elevated levels of GGT: mainly alcoholic cirrhosis or
individuals who are heavy drinkers
• Serum Bilirubin:
• Bilirubin is a bile pigment derived from the
breakdown of Haemoglobin
• Normal value: 0.1 – 1.2 mg/100ml
 Urinalysis
• This is routinely performed with ‘dip-sticks’.
• It may reveal:
– Glycosuria, which may suggest DM
– Ketonuria, which may be a sign of diabetic
ketoacidosis or starvation
– Bilirubin or urobilinogen, which may indicate
hepatobiliary disorders.
– Proteinuria, which may be due to menstruation,
or indicate renal, urinary tract or cardiac disease
– Hematuria, which may be due to menstruation, or
indicate renal or urinary tract disease.
 Markers of Renal Function
As markers of renal function creatinine, urea,
uric acid and electrolytes are done for routine
analysis.
Serum creatinine
• Creatinine is filtered but not reabsorbed in
kidney.
• Normal range is 0.8-1.3 mg/dl in men and 0.6-
1 mg/dl in women.
 Blood urea

Markers of Renal Function

• Serum uric acid
• Metabolic end product of nucleoprotein.
• Normal value: 4-8.5 mg/dl for male and
2.8-7.5mg/dl for female
• Increases in gout, leukemias, lymphomas,
anemia, patients on diuretics
 Glomerular Function Tests
• The Glomerular filtration rate (GFR) is the best
measure of glomerular function.
• Normal GFR is approximately 125 mL/min
• When GFR is 5% to 10% of normal
– Kidney failure / end-stage renal disease (ESRD).
• Inulin clearance and creatinine clearance are
used to measure the GFR.
 Oral Manifestations
• Stomatitis, gingivitis,
• A bad taste and odor in the mouth, particularly
in the morning, an ammoniacal odor
• White plaques called “uremic frost” and
occasionally found on the skin can be found
intraorally, although rarely.
• Significant xerostomia, probably caused by a
combination of direct involvement of the
salivary glands, chemical inflammation,
dehydration, and mouth breathing.
 Saliva Chemistry
• Salivary function studies include:
– Measurement of Na, K, Cl concentration in saliva
– Measurement of total salivary flow
– Rate of flow of saliva from orifices
– Rate of discharge of radio-opaque dye from
salivary gland following retrograde sialography
– Rate of uptake and secretion of 99m Tc-
pertechnate by salivary glands
• Normal values for unstimulated saliva are
– K - 25 mEq/L
– Na - <10 mEq/L
– Cl - 15-18 mEq/L
• Increase in K or Na values may indicate
generic inflammation or sialodenosis
• In Sjogren’s Syndrome
– Flow rate is reduced
– Salivary phosphate conc. is reduced
– Na & Cl conc. is elevated
– Salivary IgA conc. elevated
– Urea and K conc. unchanged
– Abnormal protein bands can be distinguished by
electrophoresis
Microbiology
 Microbiology
• Culture and sensitivity tests are used to isolate
and identify causative microorganisms of an
infection.
• May be obtained from blood or urine
• Particularly helpful in evaluating infections
related to throat, sinuses, root canals or bone.
• Sensitivity tests may also be ordered when
patient relapses, the identification of the
organism is uncertain or the disease is severe
– Most common limitation is the delay in receiving
 the report
Immunofluorescence Procedure
• This procedure employs the use of fluorescent
labelled antibodies to detect specific Ag-Ab reaction
of known specificity in tissue sections
• When tissue sections labelled in this fashion are
illuminated with UV light in an UV microscope,
specific labelled tissue component can be identified
by their bright apple green fluorescence against a
dark background
 Histopathology and
Cytopathology
• Histopathology refers to the
microscopic examination of
tissue in order to study the
manifestations of the disease

• Cytopathology refers to the

scientific study of role of
individual cells or cell types
in disease
 Tissue Biopsy
• A biopsy is a controlled & deliberate removal
of tissue from a living organism for the
purpose of microscopic examination
• Relatively simple procedure producing little
discomfort when compared to exodontia or
periodontal surgery.
• Indications:
– When signs and symptoms of an observed tissue
change do not provide enough information to make
a diagnosis
 Tissue Biopsy
• Contraindication
– The systemic health of the patient may
contraindicate biopsy completely or at least cause
its postponement.
– Site of the lesion may pose a risk to biopsy (for eg.
Biopsy in richly vascularized areas may pose a
risk of hemorrhage).
– Cases of clinically obvious malignant neoplasm
should be referred directly to the appropriate
specialist as biopsy would delay definitive care
rather than accelerate it.
 Tissue Biopsy
• Avoidance of Delay for Biopsy:
– Rapid growth
– Absent local factors
– Fixed lymph node enlargement
– Root resorption with loosening of teeth
– History of malignancy
 Tissue Biopsy
• Uses:
– Diagnosis
– Grading of tumors
– Metastatic lesions
– Recurrence
– Management Assessment
 Tissue Biopsy Types

Excisional Incisional Punch

Biopsy Biopsy Biopsy
With this technique
Total excision of a Performed by the surgical defect
small lesion for removing a produced is small
microscopic exam. wedge shaped and does not
Diagnostic + specimen of require suturing
Therapeutic pathological Tissue is removed
tissue along with in same manner as
surrounding incisional/excisiona
normal zone l
 Tissue Biopsy Interpretation
• The biopsy report communicates the
pathologist’s opinions concerning the
specimen to the practitioner.
• The format includes:
– Patient summary
– Gross description of the specimen
– Microscopic description of the specimen
– The diagnosis
– Additional comments
 Exfoliative Cytology
• The surface of the lesion is either wiped with a
sponge material or scraped to make a smear.
• The appreciation of the fact that some cancer
cells are so typical that they can be recognized
individually has allowed the development of
this diagnostic technique.
 Exfoliative Cytology
Advantages: Disadvantage Indications:
s:
• Time saving • Firm tumours • Patient preference
• Painless • False negative • Rapid evaluation
• Low cost
results • Population
• No anaesthesia
• Screening test • Non
screening
assessment
• Rapid diagnosis
 Exfoliative Cytology
• Interpretation:
 Fine Needle Aspiration Cytology
(FNAC)
• Microscopic examination of an aspirate
obtained by inserting a fine needle into a
lesion
• Painless and safe procedure for rapid diagnosis
• Indications:
– Salivary gland pathology
– As a replacement for extensive biopsy
– Cystic lesions
– Suspicious lymph nodes
– Recurrence
– Metastatic lesion

Conclusion
• Lab investigations have become an integral
component of a complete examination of the
patient.
• They confirm the authenticity of our clinical
impression and also provides a prognostic
know how post treatment.
• As oral physician we should have thorough
knowledge about different investigations
pertaining to our field of study.
• We should also know how to correlate our