Oral Medicine, Oral Pathology and Oral Diagnosis
Oral Medicine, Oral Pathology and Oral Diagnosis
This domain integrates the diagnosis and management of oral mucosal diseases, salivary gland disorders, and oral manifestations of systemic diseases. Key areas include oral potentially malignant disorders (leukoplakia, erythroplakia, oral submucous fibrosis), oral cancer (squamous cell carcinoma), vesiculobullous diseases (pemphigus, pemphigoid), and infections (candidiasis, herpes). You must know the clinical features, diagnostic tests (biopsy, cytology, serology), and management principles.
Traps: Distinguish between reticular and erosive lichen planus; the erosive type has a higher malignant transformation potential. Another trap is the difference between pemphigus vulgaris (intraepithelial, positive Nikolsky sign) and bullous pemphigoid (subepithelial, negative Nikolsky). In oral cancer, the most common site is the lateral border of the tongue; risk factors include tobacco, alcohol, and HPV (especially HPV-16 for oropharyngeal cancer).
Rule of thumb: Any ulcer that persists for more than two weeks without a clear cause should be biopsied. For pigmented lesions, remember the ABCDE rule (Asymmetry, Border, Color, Diameter, Evolution).
Worked example: A 60-year-old smoker presents with a non-healing ulcer on the lateral tongue. Differential diagnosis includes squamous cell carcinoma. Management: incisional biopsy for histopathology. If confirmed, staging (TNM) and multidisciplinary treatment.