Management of Oral and Maxillofacial Disease
From diagnosis to plan
Management questions test whether you select the correct next step, not the definitive treatment. The sequence is stabilization, definitive diagnosis, then therapy. Know when to refer and to whom: oral and maxillofacial surgery for biopsy of suspicious lesions and odontogenic infections with fascial space involvement; oral medicine for immune-mediated and mucosal disease; oncology for confirmed malignancy.
Infection and emergencies
For odontogenic infection, assess airway, swallowing, and fascial space involvement. Trismus, dysphagia, elevation of the floor of the mouth, and systemic toxicity demand urgent referral and drainage plus antibiotics; a fluctuant swelling without systemic signs may be managed with drainage and oral antibiotics. Trap: prescribing antibiotics alone for a drainable abscess. Another trap: delaying referral for a rapidly expanding neck swelling.
Mucosal and systemic disease
Recurrent aphthous ulcers: topical corticosteroids first-line; systemic therapy for severe or refractory cases. Oral candidiasis: topical antifungals, with systemic agents for refractory or immunocompromised patients. Lichen planus: topical corticosteroids; monitor for malignant transformation. Pemphigus and pemphigoid: dermatology co-management with systemic immunosuppression. Know that topical anesthetics relieve symptoms but do not treat disease.
Surgical and adjunctive principles
Understand indications for extraction versus endodontic retention, biopsy technique, hemostasis, and antibiotic prophylaxis. Prophylaxis is reserved for specific cardiac conditions, not routine prosthetic joints. Postoperative instructions, analgesia, and follow-up are commonly tested.
Worked rule of thumb
Ask three questions in order: Is this an emergency? (airway, bleeding, malignancy) → Do I have a diagnosis? (if not, biopsy or refer) → What is the least invasive effective therapy? This ladder prevents both under-referral and overtreatment.
Traps
Questions reward conservative, evidence-based steps and punish premature definitive treatment before diagnosis.