Oral Pathology with Dr. Padilla Monday, February 18, 2013 7: 03 pm

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Oral Pathology with Dr. Padilla

Monday, February 18, 2013

7:03 PM

Ricardo J. Padilla: Oral and Maxillofacial Pathologist at UNC School of Dentistry





Audio recording started: 7:04 PM Monday, February 18, 2013




  • Keep patients as #1 priority

  • Most dentists work until they are 55 or 65

  • Oral pathologists are a different breed: problem solver


  • 43 HM with oral lesions

*Picture of swollen upper and lower jaw: specifically, MK lymphoma

  • First things oral pathologists use are radiograph and head/neck examination

  • Can see broken down teeth and huge cavities

  • Gather significant evidence and interview the patients before the appointment (medical questionnaire)

  • Take biopsy of infected area and make a final diagnosis

  • With treatment, he had treatment including chemotherapy and he is now 6 years lymphoma free

What is oral and maxillofacial pathology?

  • Specialty of dentistry and discipline of pathology that deals with the nature, identification and management of diseases affecting the oral regions.

  • It is a science investigating the causes, processes and effects of diseases.

  • The practice of oral path includes research and diagnosis of diseases using clinic, radiographic, microscopic, etc. practice.

We spend lots of time at the microscope!

  • Picture of microbiology

We know anatomy really well!

  • Picture of patient with lessions of maxilla

  • Oral pathologists are also teachers!

How did I get here?

  • Undergrad, dental school, residency (3 average), fellowship equaling 12 years

Oral pathologists are a hybrid between a dermatologists and pathologist since they "put it all together"

  • 80% of skin infections are from the mouth

  • In the mouth, there is an organ that doesn’t occur anywhere else: tooth

  • Deal with oral cancer

    • 3 most important factors for oral cancer

      • Tobacco (any form)

      • Alcohol (in excess)               *alcohol and tobacco together is exponentially worse

      • HPV (related to oral sex)--7 or more individuals is almost 100%

        • HPV is a DNA virus that is ibiquitous. 110 different subtypes of HPV. We all have been exposed of HPV (warts, papillomas, etc.)

        • For an individual that has had oral sex with 7 or more people, if they came in contact with a high risk HPV person, the risk is 100% for getting oral cancer

          • HPV needs to go all the way to the basil cell with a slight cut in the mouth (transmission), then you are infected with low or high risk. The virus isn't capable of doing a lot without machinery. It will start going to the nucleus to get the cell to make its DNA. At that point the virus, will be episomal existence (not inserted into DNA yet). The virus can become integrated into the DNA if it gets inserted into the DNA. It can become proliferated. If you have a high risk HPV, you will have a cancer; if low risk, you will have a wart.


A college student went to her dentist and he found a lesion

  • Picture of lesion in mouth: more specifically, a wart in the mouth "squamous papilloma" from HPV: low risk virus


Do oral pathologists work in academic or private setting?

  • Usually, academia. Oral pathologists are slightly more cerebral than dexterous

  • Lower range salary or earings in dentistry

  • Also some oral path labs

How is your lifestyle?

  • No days are alike

  • One week: Wake up at 5am. Works out for triathalons. Get into work at 8-9am. Go to clinic to see patients for 3-4 hours (4-15 patients--not drill and fill), have to have journal club residencies. Around noon, do academics (1 hr long). Lunch at the microscopic with residents looking at cases (2-3 hrs). At 2pm, look at cases and patients related stuff while teaching dental students. At 5pm, paper pusher. Head out of office at 6pm. Have dinner, kids go to bed. After that, reads and studies cases and does research. Goes to bed.

    • There are very few oral path emergencies where you have to stop what you are doing

Did you know about oral pathology before or during dental school?

  • He had no idea what oral pathology was before dental school?

  • When he was 17, he wanted to be a dentist (saw good life, good car, etc.)

    • Didn’t want to be a pediatrician like his dad

    • Thought he was going to be a "rich orthodontics"

      • Thought ortho was really boring--physics and mechanics

      • So he switched to oral surgery (assisting surgeon, volunteer surguries for craniofacial  cases)...was lined up to go into oral surgery

      • Then found oral pathology and knew that what he wanted to do. He didn't want to push blood and be with people that have trouble bleeding

      • He would work for free if need be

Success/failure rate for solving cases?

  • A lot of his patients pass away

  • Success rate of dealing with patients: 98-99%

    • There are a few cases that they never find out what they have or came out too late

    • That does not mean that they are easy cases whatsoever

      • Has a patient who he has worked on for 2 hrs/day for 2 weeks and still don't know what it is

    • Nothing in dentistry is 100%

    • The satisfication stage is 100% though, because in oral path, he knows he kept the patient as his focus of attention 100% of the time...very satisfying

Directory: files -> 2013
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