Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2020) – 128.41
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI – 0.5
Average rejection rate (2021) – 81.35%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

Download PDF

Dental and Medical Problems

2019, vol. 56, nr 3, July-September, p. 299–306

doi: 10.17219/dmp/108597

Publication type: review article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

Clinicians’ role in the occurrence of oral biopsy artifacts as a potential diagnostic dilemma

Rola lekarzy klinicystów w powstawaniu artefaktów w badaniu histopatologicznym jamy ustnej jako możliwy dylemat diagnostyczny

Massoumeh Zargaran1,A,B,C,D,E,F

1 Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Kurdistan University of Medical Sciences, Sanandaj, Iran


A lack of knowledge about biopsy techniques and the management of biopsy specimens can cause artifacts. Artifacts are false structures that change the normal morphological and cytological features of tissues. This review article aimed to familiarize clinicians / dentists / surgeons with the factors causing artifacts and with the efficient strategies to prevent or minimize their occurrence. Non-adherence to several rules can result in the formation of artifacts. The clinician’s performance during and after the surgical procedure (until the sample is received by the laboratory) may damage the biopsy specimen or make it susceptible to damage. Artifacts may not be clinically considered noteworthy. However, by modifying the histopathological features of the specimen, they can lead to serious errors in the interpretation of lesions. Knowledge on the part of clinicians / dentists / surgeons regarding the factors and potential conditions that can lead to artifacts can decrease the risk of their occurrence, and considerably help pathologists and patients by paving the way for a correct diagnosis, and consequently an appropriate treatment plan.

Key words

biopsy, dentist, artifact, oral lesion

Słowa kluczowe

biopsja, dentysta, artefakt, zmiana patologiczna w jamie ustnej

References (39)

  1. López Jornet P, Velandrino Nicolás A, Martínez Beneyto Y, Fernández Soria M. Attitude towards oral biopsy among general dentists in Murcia. Med Oral Patol Oral Cir Bucal. 2007;12(2):E116–E121.
  2. James K, Toner M, Stassen LF. Performing mucosal tissue biopsies in general dental practice. J Ir Dent Assoc. 2011;57(4):203–208.
  3. Kumaraswamy KL, Vidhya M, Rao PK, Mukunda A. Oral biopsy: Oral pathologist’s perspective. J Cancer Res Ther. 2012;8(2):192–198.
  4. Avon SL, Klieb HB. Oral soft-tissue biopsy: An overview. J Can Dent Assoc. 2012;78:c75.
  5. Rastogi V, Puri N, Arora S, Kaur G, Yadav L, Sharma R. Artefacts: A diagnostic dilemma – a review. J Clin Diagn Res. 2013;7(10):2408–2413.
  6. Melrose RJ, Handlers JP, Kerpel S, Summerlin DJ, Tomich CJ; American Academy of Oral and Maxillofacial Pathology. The use of biopsy in dental practice. The position of the American Academy of Oral and Maxillofacial Pathology. Gen Dent. 2007;55(5):457–463,468.
  7. Mota-Ramírez A, Silvestre FJ, Simó JM. Oral biopsy in dental practice. Med Oral Patol Oral Cir Bucal. 2007;12(7):E504–E510.
  8. Jephcott A. The surgical management of the oral soft tissues: 3. Biopsy. Dent Update. 2007;34(10):654–657.
  9. Manyam R, Reena K, Saraswathi TR. Role of deeper sections in diagnostic oral histopathology: A retrospective study. Indian J Dent Res. 2011;22(1):62–65.
  10. Wan A, Savage NW. Biopsy and diagnostic histopathology in dental practice in Brisbane: Usage patterns and perceptions of usefulness. Aust Dent J. 2010;55(2):162–169.
  11. Saini R, Saini S, Sharma S. Oral biopsy: A dental gawk. J Surg Tech Case Rep. 2010;2(2):93.
  12. Logan RM, Goss AN. Biopsy of the oral mucosa and use of histopathology services. Aust Dent J. 2010;55(Suppl 1):9–13.
  13. Bindhu P, Krishnapillai R, Thomas P, Jayanthi P. Facts in artifacts. J Oral Maxillofac Pathol. 2013;17(3):397–401.
  14. Allen CM. The oral pathology report: Submission of specimens and interpretation of results. Dermatol Ther. 2002;15(3);179–184.
  15. Poh CF, Ng S, Berean KW, Williams PM, Rosin MP, Zhang L. Biopsy and histopathologic diagnosis of oral premalignant and malignant lesions. J Can Dent Assoc. 2008;74(3):283–288.
  16. Camacho Alonso F, López Jornet P, Jiménez Torres MJ, Orduña Domingo A. Analysis of the histopathological artefacts in punch biopsies of the normal oral mucosa. Med Oral Patol Oral Cir Bucal. 2008;13(10):E636–E639.
  17. Pippi R. Technical notes about soft tissues biopsies of the oral cavity. Minerva Stomatol. 2006;55(10):551–566.
  18. Atanda AT, Raphael S. Role of surgeons in determining outcome of histopathology specimens. Niger J Surg. 2013;19(2):68–72.
  19. Jain N. Essentials before sending biopsy specimens: A surgeon’s perspective and pathologists concern. J Maxillofac Oral Surg. 2011;10(4):361–364.
  20. Kumar K, Shetty DC, Dua M. Biopsy and tissue processing artifacts in oral mucosal tissues. Int J Head Neck Surg. 2012;3(2):92–98.
  21. Khan S, Tijare M, Jain M, Desai A. Artifacts in histopathology: A potential cause of misinterpretation. Research & Reviews: Journal of Dental Sciences. 2014;2(2):23–31.
  22. Seoane J, Varela-Centelles PI, Ramírez JR, Cameselle-Teijeiro J, Romero MA. Artefacts in oral incisional biopsies in general dental practice: A pathology audit. Oral Dis. 2004;10(2):113–117.
  23. Handlers JP. Diagnosis and management of oral soft-tissue lesions: The use of biopsy, toluidine blue staining, and brush biopsy. J Calif Dent Assoc. 2001;29(8):602–606.
  24. Chatterjee S. Artefacts in histopathology. J Oral Maxillofac Pathol. 2014;18(Suppl 1):S111–S116.
  25. Margarone JE, Natiella JR, Vaughan CD. Artifacts in oral biopsy specimens. J Oral Maxillofac Surg. 1985;43(3):163–172.
  26. Oliver RJ, Sloan P, Pemberton MN. Oral biopsies: Methods and applications. Br Dent J. 2004;196(6):329–333.
  27. Christensen GJ. Soft-tissue cutting with laser versus electrosurgery. J Am Dent Assoc. 2008;139(7):981–984.
  28. Yanduri S, Pandey G, Kumar VB, Suma S, Madhura MG. Artifacts in oral biopsy specimens: A comparison of scalpel, punch, and laser biopsies. Indian J Oral Health Res. 2016;2(2):100–105.
  29. Davari P, Fazel N. Practical pearls for oral procedures. Clin Dermatol. 2016;34(4):440–448.
  30. Masthan KM, Sankari SL, Babu NA, Rajguru JP. How to help the oral pathologist in making an accurate diagnosis. J Clin Diagn Res. 2013;7(1):181–184.
  31. Romeo U, Palaia G, Del Vecchio A, et al. Effects of KTP laser on oral soft tissues. An in vitro study. Lasers Med Sci. 2010;25(4):539–543.
  32. Singhal P, Singh NN, Sreedhar G, Banerjee S, Batra M, Garg A. Evaluation of histomorphometric changes in tissue architecture in relation to alteration in fixation protocol – an in vitro study. J Clin Diagn Res. 2016;10(8):ZC28–ZC32.
  33. Sengupta S, Prabhat K, Gupta V, Vij H, Vij R, Sharma V. Artefacts produced by normal saline when used as a holding solution for biopsy tissues in transit. J Maxillofac Oral Surg. 2014;13(2):148–151.
  34. Comănescu M, Arsene D, Ardeleanu C, Bussolati G. The mandate for a proper preservation in histopathological tissues. Rom J Morphol Embryol. 2012;53(2):233–242.
  35. Comanescu M, Annaratone L, D’Armento G, Cardos G, Sapino A, Bussolati G. Critical steps in tissue processing in histopathology. Recent Pat DNA Gene Seq. 2012;6(1):22–32.
  36. Sleiman R, Kurban M, Abbas O. Maximizing diagnostic outcomes of skin biopsy specimens. Int J Dermatol. 2013;52(1):72–78.
  37. Patil S, Rao RS, Agarwal A, Raj AT. Instant transport media for biopsied soft tissue specimens: A comparative study. Scientifica (Cairo). 2015;2015:876531.
  38. Start RD, Cross SS, Smith JH. Assessment of specimen fixation in a surgical pathology service. J Clin Pathol. 1992;45(6):546–547.
  39. Dimenstein IB. Grossing biopsies: An introduction to general principles and techniques. Ann Diagn Pathol. 2009;13(2):106–113.