Oral Pathology Without the Panic: Andreina Sucre, The Patho RDH, on Oral Lesions, Critical Thinking, and Starting Over

Episode 21: Meet Andreina Sucre, The Patho RDH

In Episode 21 of The Unhinged Hygienists, Lauren Kennedy, RDH and Anastasia Dallas, RDH sit down with Andreina Sucre, The Patho RDH. Born in Caracas, Venezuela, Andreina earned her dental degree and later completed training in oral surgery and oral pathology in Colombia. After immigrating to the United States, she rebuilt her clinical career as a dental hygienist and transformed her specialist knowledge into an approachable teaching platform for the hygiene community.

Her story connects two conversations dental professionals urgently need: how to examine and document oral lesions with more confidence, and what it takes for an internationally trained clinician to begin again without abandoning the knowledge, identity, and purpose earned along the way.

Key Takeaways From Episode 21

• Oral pathology is not an image-matching contest; history, location, color, surface, borders, size, consistency, duration, symptoms, and change over time all matter.
• A structured description helps the next clinician understand what was actually observed and whether the lesion is changing.
• Grouping lesions by clinical appearance — white, red, ulcerated, raised, or pigmented — can make a differential diagnosis less overwhelming.
• Dental hygienists can detect and document abnormalities, but a definitive diagnosis may require evaluation and biopsy by an appropriately qualified clinician.
• Normal-looking or painless does not always mean harmless; potentially malignant oral disorders may be asymptomatic.
• Bilingual communication can improve the history clinicians collect and help Spanish-speaking patients understand why follow-up matters.
• Internationally trained dentists may bring deep clinical expertise into dental hygiene while navigating a difficult professional reset in the United States.
• Imposter syndrome does not disappear before a big opportunity; Andreina built her speaking career by moving forward while the doubt was still present.

From Dentist in Venezuela to Oral Pathology Specialist

Andreina grew up enjoying dental visits — even the unmistakable smell of acrylic in the office. Dentistry represented creativity, autonomy, and financial independence. She eventually practiced in the same building as the dentist who had helped shape that early positive experience, a full-circle moment she remembers as proof that one clinician can alter the direction of a young patient's life.

She entered a dual oral surgery and oral pathology residency expecting surgery to be the exciting part. Instead, pathology won her over. Surgery brought adrenaline; oral pathology demanded quiet observation, disciplined reasoning, and the satisfaction of assembling clues. That detective work became the foundation of The Patho RDH.

Why Oral Pathology Feels So Intimidating to Hygienists

Many clinicians remember oral pathology as hundreds of slides paired with hundreds of names. The predictable result is fear: if the lesion in front of you does not look exactly like the textbook photo, confidence disappears. Andreina's answer is to replace recall-first learning with a repeatable clinical process.

Start with what is observable. Is the finding white, red, ulcerated, pigmented, or a growth? Is it flat or raised, single or multiple, smooth or rough, wipeable or fixed? Where is it, how large is it, how long has it been present, and has it changed? What symptoms, exposures, medications, habits, trauma, or medical history could matter? Those questions do not produce a diagnosis by themselves, but they produce a far more useful clinical record and a safer next step.

How to Describe an Oral Lesion Clearly

A note that says only 'lesion on cheek' gives the next clinician almost nothing to compare. A strong oral lesion description should capture the site, size, shape, color, border, surface texture, whether it is flat or elevated, whether it can be wiped away, tenderness, firmness, duration, and any documented change. A clinical photograph may supplement the written description when office policy and patient consent allow it.

• Location: use precise anatomy and note right, left, midline, or bilateral presentation.
• Dimensions: record measurable length and width rather than 'small' or 'large.'
• Morphology: macule, plaque, papule, nodule, vesicle, ulcer, or mass when appropriate.
• Color and surface: white, red, mixed, brown, blue, smooth, papillary, crusted, or keratotic.
• Borders and consistency: well-defined or diffuse; soft, firm, fluctuant, or indurated when palpation is appropriate.
• Timeline and symptoms: onset, duration, recurrence, pain, bleeding, numbness, growth, and known triggers.
• Plan: comparison interval, referral, communication with the dentist, and follow-up outcome.

White, Red, Ulcerated, Raised, or Pigmented: A Practical Starting Framework

Andreina and co-author Amber, The Latina RDH, organized their bilingual oral pathology resource by clinical appearance. That matters because clinicians do not begin an exam with a pathology label; they begin with a finding. A white lesion might reflect friction, infection, immune-mediated disease, or a potentially malignant disorder. A persistent red lesion, unexplained ulcer, growing mass, or changing pigmented area also deserves systematic evaluation rather than a casual guess.

The framework is a starting point, not a shortcut to diagnosis. Oral conditions can resemble one another, and the same condition can appear differently between patients. When a lesion is persistent, unexplained, changing, indurated, associated with neurologic symptoms, or otherwise concerning, the appropriate response is timely evaluation and referral — not reassurance based on one photograph.

Oral Cancer Screening: Detection Is Not Diagnosis

Dental hygienists are well positioned to notice tissue changes because they see patients regularly and examine areas patients cannot easily inspect themselves. The American Dental Association recommends a conventional visual and tactile examination for adult patients. That exam can identify abnormalities and trigger follow-up, but screening is not the same as diagnosing oral cancer.

A suspicious finding may need referral, biopsy, and clinicopathologic correlation. HPV is strongly linked with many cancers of the oropharynx — including the tonsils and base of tongue — while tobacco and alcohol remain important risk factors for cancers of the oral cavity. The practical lesson is not to create panic. It is to examine consistently, document precisely, communicate clearly, and close the loop on referrals.

The Bilingual Oral Pathology Book Built for Real Appointments

Andreina originally placed an English oral pathology book on her vision board. Amber proposed a bigger idea: combine oral pathology with dental Spanish. Their resulting resource is designed primarily for English-speaking clinicians while adding Spanish phrases and pronunciation support that can help gather a history, explain a finding, and communicate the need for follow-up.

Language access matters clinically. A patient may describe burning, duration, recurrence, trauma, medication use, or a change in size only if the question is understood. A bilingual reference does not replace a qualified interpreter when one is needed, but it can help clinicians avoid silence, build trust, and recognize when more language support is necessary.

From International Dentist to Dental Hygienist in the United States

Immigration changed Andreina's title, but it did not erase her education. After moving to the United States, she eventually pursued dental hygiene licensure in Florida. She describes the emotional difficulty of going from dentist and specialist to rebuilding inside a different system — and the decision to become an excellent hygienist rather than treat hygiene as a lesser destination.

Her experience also complicates simplistic arguments about internationally trained dentists entering dental hygiene. Licensing rules vary by state, and internationally educated clinicians do not write those rules. Andreina calls for honest conversation rather than resentment: protect standards, understand the pathway, and recognize the expertise and cultural knowledge these clinicians may bring to patient care.

Imposter Syndrome, Accents, and Becoming a National Speaker

Andreina first imagined speaking about the immigrant professional experience. Amber saw the expertise hiding in plain sight and asked why an oral pathologist was not teaching oral pathology. That nudge helped Andreina shape The Patho RDH and eventually speak for RDH Under One Roof, ADHA, and dental hygiene associations.

The confidence did not arrive first. Andreina describes rehearsing unfamiliar English words before presenting and hearing the internal voice that questions whether she belongs. Her career is proof that expertise can coexist with an accent, uncertainty, and a nonlinear résumé. She attended RDH Under One Roof on a tight budget, decided she would someday teach there, and returned as a selected speaker — repeatedly.

The Unhinged Bottom Line

Oral pathology becomes less frightening when clinicians stop demanding an instant name and start asking better questions. Describe what you see. Compare it over time. Know the limits of screening. Refer when the finding is persistent or concerning. And never assume that beginning again means beginning from zero. Andreina Sucre carried dentistry, surgery, pathology, language, motherhood, immigration, and resilience into her work as The Patho RDH — and the hygiene profession is stronger for it.