Four exams had been taken, countless practicals were turned in, and NYU Dentistry had shut down overnight. For a little over 6 months, patients were unable to receive dental care and students were unable to learn in person. When remote school started, most of our courses just resumed from where COVID had cut them off. However, one course, Oral and Maxillofacial pathology and radiology, brooded in the depths of Zoom, foreshadowing an intense and stressful summer.
June started without the lit up NYC bars or previously planned beach trips - just the continued “science-fiction movie comes to life” stay at home orders. Studying for the boards made each day inside no different from the next, and just like that, OMPR began. Freaky lesions began to dot my Zoom screen, and multiple differential diagnoses began to define the strange cutaneous manifestations. This aside, I started to feel as though my training could change someone’s life.
My mom had told me her friend was at a routine checkup at the dentist when the dentist discovered her tongue cancer. While I knew having the knowledge to identify head and neck cancers was incredible, I did not know the agonizing trajectory of these pathologies. My professor, Dr. Kerr, showed us photographs of the malformations that occurred as a result of head and neck cancers as well as the surgeries, such as fibula grafts, needed to treat them. I suddenly realized the importance of graduating as a dentist that served as the primary screener preventing these tragic courses from unfurling. We spent the entirety of the course learning how to identify and differentiate head and neck cancers, diseases, and tumors.
I particularly enjoyed learning about ameloblastomas because of their mysterious ways. Ameloblastomas resemble a tumor in the jaw, developing near the molars; however, the lesions usually present as benign despite the potential facial distortion that some patients experience. Ameloblastomas must be diagnosed and treated early due to their small possibility of eventual malignant prognosis. I found the radiographic appearance spectacular, appearing as multilocular and willowy radiolucencies with white cortices. This specific imagery distinguishes the often benign pathology of ameloblastomas from more worrisome cancers -- tumors resembling moth eaten jaws and cortices hanging by threads.
I also learned about calcifying odontogenic cysts which resemble spackled paint within a radiolucent circle above a tooth on an X-ray. The benign nature of these lesions could be felt just by the absence of half eaten jaw distortion. I also found leukoplakias fascinating. These lesions appear often, but can progress to malignancies. While the cause is often simple, repeated trauma or irritation to the submucosa, they can also foreshadow precancerous changes in the mouth. Therefore, careful clinical analysis can lead to life saving biopsies as a dentist.
This course taught me the importance of colors and the intricate difference between a radiolucency and a radiopacity. The mouth opens windows to stories and mysteries that can manifest simply as a color or shade.
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