Oral Medicine, Oral Pathology, and Oral Diagnosis
Core concepts
Understand the diagnostic process: history, extraoral and intraoral examination, differential diagnosis, and when to biopsy. Know the appearance and behaviour of common mucosal disease: recurrent aphthous stomatitis, oral candidiasis, lichen planus, leukoplakia and erythroplakia, oral submucous fibrosis, pemphigus and mucous membrane pemphigoid, and herpes infections. Know red flags for malignancy: a non-healing ulcer over three weeks, induration, fixation, lymphadenopathy, and unilateral symptoms.
Pathology
Be able to describe odontogenic cysts and tumours (radicular cyst, dentigerous cyst, odontoma, ameloblastoma), fibro-osseous lesions, and salivary gland disease including mucocele, sialadenitis, and neoplasms. Know that lymphoma and squamous cell carcinoma are the key malignancies and that any suspicious lesion needs referral, not empirical treatment.
Traps
Questions frequently confuse lichen planus (bilateral, reticular, Wickham striae) with leukoplakia (a diagnosis of exclusion). Another trap is treating a persistent ulcer with antifungal or steroid therapy without review - always set a review date and refer if it does not resolve. Distinguish recurrent aphthous ulcers (recurrent, multiple, small) from a single persistent ulcer, which is suspicious.
Rule of thumb
Any ulcer or white or red patch persisting beyond two to three weeks after removing local causes requires referral for assessment, usually with biopsy.
Worked example
A 60-year-old with a painless, indurated 2 cm ulcer on the lateral tongue and a firm submandibular node: this is suspicious for squamous cell carcinoma and needs urgent referral, not a topical steroid trial.