Oral Surgery and Oral Medicine
Assessment and risk
Oral surgery questions emphasize preoperative assessment: medical history, bleeding risk, anticoagulant management, airway, and anatomic considerations. Know the indications and contraindications for extraction, the principles of flap design, and the management of complications such as bleeding, dry socket, and nerve injury. Oral medicine requires recognizing mucosal lesions, distinguishing benign from potentially malignant disorders, and knowing when biopsy is mandatory.
Traps in question stems
Common traps include stopping anticoagulants without consultation, ignoring red flags in a mucosal lesion, and missing the difference between a swelling that needs urgent drainage and one that can be observed. Questions may test the management of a patient on bisphosphonates or with a history of head and neck radiation, where extraction carries osteonecrosis risk. Another trap is assuming all ulcers are aphthous when a persistent, indurated, nonhealing ulcer requires biopsy.
Rule of thumb
Use the "two-week rule": any oral ulcer or lesion that has not healed within two weeks despite removal of an obvious cause warrants biopsy or referral. For bleeding risk, coordinate with the prescriber rather than unilaterally stopping medication.
Worked example
A patient on warfarin for a mechanical valve needs an extraction. The correct approach is to check the INR and coordinate with the managing physician; do not simply stop the anticoagulant. Local hemostatic measures may suffice if the INR is in range.