Oral Surgery and Oral Medicine
What the exam expects
This domain covers exodontia, surgical principles, complications, local anesthesia complications, odontogenic infections, oral mucosal disease, and medical management of dental patients. Oral medicine questions reward pattern recognition: lesion appearance plus location plus history equals diagnosis.
Core concepts to master
- Extraction and surgical principles: forceps vs elevators, flap design, bone removal, atraumatic technique, socket preservation, dry socket pathophysiology and management.
- Complications: bleeding, nerve injury (lingual, inferior alveolar), oroantral communication, displacement, infection, and their immediate management.
- Odontogenic infection: spread along fascial spaces, Ludwig angina as a bilateral floor-of-mouth cellulitis, airway risk, and when to refer urgently.
- Oral mucosal disease: ulcerative, vesiculobullous, white, red, and pigmented lesions; red flags (duration >2 weeks, induration, fixation, nonhealing).
- Medically complex patients: anticoagulants, bisphosphonate-related osteonecrosis, radiation caries, and antibiotic prophylaxis thresholds.
Traps
- Calling every white lesion leukoplakia; leukoplakia is a clinical diagnosis of exclusion, not a histologic one.
- Missing that a nonhealing ulcer after 2 weeks requires biopsy or referral regardless of how benign it looks.
- Forgetting the airway first in floor-of-mouth swelling; the correct answer is urgent referral or hospital management, not an oral antibiotic and review in a week.
- Mixing up which nerve is at risk in which procedure - lingual nerve in third molar lingual retraction, inferior alveolar in deep socket instrumentation.
Rule of thumb
Use the 2-week red flag and the airway-first rule. Worked example: a patient with bilateral submandibular swelling, elevated tongue, dysphagia, and fever after a lower molar infection - the answer is immediate airway assessment and hospital referral for IV antibiotics and drainage, not outpatient oral antibiotics.