DABOM cheat sheet

Diagnostic pathway: history → extraoral/intraoral examination → provisional differential → targeted investigations → definitive diagnosis → treatment plan with review interval.

Lesion description must record site, size (mm), shape, border, base, color, texture, duration, progression, and symptoms; these features drive the differential.

Sensitivity/specificity rule: a highly sensitive test (e.g., incisional biopsy for malignancy) is used to rule out; a highly specific test is used to rule in.

Candidiasis: pseudomembranous plaques wipe off leaving erythema; erythematous form shows depapillation on the dorsum of tongue and is diagnosed by response to antifungal therapy.

Lichen planus vs lichenoid reaction: bilateral symmetry, reticular striae, and absence of a causative drug favor lichen planus; unilateral or drug-linked lesions favor lichenoid reaction.

Biopsy indications: any ulcer persisting >2 weeks without cause, induration, fixity, bleeding, or red/white patch of unknown cause; incisional biopsy is standard for large lesions.

Vital staining with toluidine blue has low specificity; it is not a substitute for biopsy and should not be used as a screening test alone.

Extraoral examination includes TMJ, salivary glands, cervical lymph nodes, cranial nerves (V, VII, IX, XII), and skin survey for mucocutaneous disease.

DC/TMD axis I: pain-related TMD (myalgia, arthralgia, headache attributed to TMD) and intra-articular disorders (disc displacement with/without reduction, degenerative joint disease, subluxation).

Myofascial pain criterion: pain in masticatory muscles modified by jaw function, plus palpation-induced familiar pain in the muscle.

Disc displacement with reduction: reciprocal click, reproducible on opening and closing; with reduction and intermittent locking adds locking episodes.

Disc displacement without reduction: limited opening (<40 mm), deviation to the affected side, history of click that ceased, and no joint sounds.

Arthralgia: pain in TMJ region modified by jaw movement and familiar pain on palpation of the joint; crepitus suggests degenerative joint disease.

Red flags for orofacial pain: unilateral persistent pain, cranial nerve deficits, unexplained weight loss, dysphagia, or pain awakening from sleep require urgent workup.

Trigeminal neuralgia: paroxysmal electric-shock pain in V2/V3 distribution, triggered by touch/cold/chewing, with refractory periods; carbamazepine is first-line.

Burning mouth syndrome: bilateral burning of tongue/lips without mucosal abnormality, often in postmenopausal women, with no identifiable organic cause; consider secondary causes first.

Recurrent aphthous stomatitis: minor (<10 mm, heals <14 days), major (>10 mm, heals weeks, scarring), and herpetiform (multiple small clustered ulcers).

Behçet disease: recurrent oral ulcers plus at least two of genital ulcers, eye lesions, skin lesions, or positive pathergy test.

Oral lichen planus: reticular (Wickham striae), erosive, plaque, atrophic, and bullous forms; malignant transformation risk is low but requires long-term review.

Pemphigus vulgaris: flaccid bullae, positive Nikolsky sign, intraepithelial IgG deposition, anti-desmoglein 1 and 3 antibodies; oral lesions often precede skin.

Mucous membrane pemphigoid: subepithelial blisters, gingival desquamation, linear IgG/C3 at basement membrane; risk of ocular and airway scarring.

Erythema multiforme: target lesions, often triggered by HSV or drugs; major form involves mucosa with hemorrhagic crusting of lips.

Oral candidiasis risk factors: inhaled corticosteroids, xerostomia, diabetes, HIV, denture wearing, and broad-spectrum antibiotics.

Geographic tongue (benign migratory glossitis): migrating depapillated erythematous patches with white borders, often asymptomatic; no treatment required.

Oral squamous cell carcinoma risk: tobacco, alcohol, areca nut, HPV (especially oropharyngeal), and chronic immunosuppression; most common intraoral site is lateral tongue and floor of mouth.

Red flags for malignancy: ulcer >2 weeks, induration, fixity to deeper tissues, spontaneous bleeding, paresthesia, and cervical lymphadenopathy.

Leukoplakia is a clinical diagnosis of exclusion; dysplasia on biopsy determines management, and non-homogeneous leukoplakia carries higher malignant transformation risk.

Erythroplakia has the highest malignant transformation rate among oral potentially malignant disorders.

TNM staging: T describes tumor size/invasion, N describes regional nodes, M describes distant metastasis; stage grouping guides treatment and prognosis.

Ameloblastoma: locally aggressive odontogenic tumor of mandible, radiolucent multilocular (soap-bubble) lesion; treatment is resection with margins.

Odontogenic keratocyst: high recurrence, associated with PTCH1 mutation and Gorlin syndrome when multiple.

Mucoepidermoid carcinoma: most common salivary malignancy; low-grade tumors have better prognosis; MAML2 translocation is characteristic.

Xerostomia is a symptom of dry mouth; hyposalivation is objective reduction (unstimulated whole salivary flow <0.1 mL/min, stimulated <0.7 mL/min).

Sjögren syndrome: dry eyes and mouth plus positive anti-Ro/SSA or anti-La/SSB, labial salivary gland biopsy focus score ≥1, or ocular staining; classify by ACR/EULAR criteria.

Sialolithiasis: most common in submandibular gland (Wharton duct); presents with meal-time swelling and pain; imaging by ultrasound or CBCT.

Sialadenosis: bilateral non-inflammatory parotid enlargement, often associated with diabetes, malnutrition, or medications.

Mumps parotitis: bilateral parotid swelling, prodromal fever, elevated amylase; supportive care and vaccination prevention.

Salivary gland tumor rule: parotid tumors are mostly benign; submandibular and minor salivary gland tumors have higher malignancy rates.

Radiation-induced xerostomia: severity depends on dose and volume of parotid irradiation; pilocarpine or cevimeline may be used if gland function remains.

Sialography and scintigraphy assess ductal anatomy and function; MRI is preferred for tumor evaluation.

Diabetes mellitus: increased risk of periodontitis, candidiasis, delayed healing, and xerostomia; HbA1c >7% indicates poorer glycemic control.

Anemia: iron deficiency causes glossitis and angular cheilitis; vitamin B12 deficiency causes Hunter glossitis and oral ulceration.

Leukemia: gingival enlargement, bleeding, and oral ulceration may be presenting features; urgent hematology referral is required.

HIV: oral candidiasis, hairy leukoplakia, Kaposi sarcoma, and necrotizing ulcerative periodontitis are markers of immunosuppression; CD4 count guides risk.

Medication-related osteonecrosis of the jaw: exposed bone >8 weeks in a patient on antiresorptives or antiangiogenics, without head/neck radiation history.

Pregnancy: pregnancy epulis (pyogenic granuloma) and increased gingivitis from hormonal changes; defer elective treatment to second trimester.

Anticoagulant management: do not stop warfarin for routine dental extraction if INR is within therapeutic range; local hemostatic measures are preferred.

Adrenal insufficiency: patients on long-term corticosteroids may need supplementation before stressful procedures.

First-line antifungals for oral candidiasis: nystatin suspension or clotrimazole troches for mild disease; fluconazole for moderate/severe or immunocompromised patients.

Topical corticosteroids for oral mucosal disease: triamcinolone acetonide in orabase for mild lesions; betamethasone or clobetasol for severe erosive disease, with antifungal cover.

Amoxicillin is first-line for odontogenic infection; metronidazole is added for anaerobic coverage; penicillin allergy requires clindamycin or azithromycin.

Lidocaine with epinephrine 1:100,000 provides hemostasis and prolonged anesthesia; maximum dose must account for patient weight and cardiac status.

NSAIDs are effective for odontogenic pain but carry GI, renal, and cardiovascular risks; avoid in third trimester of pregnancy.

Opioid prescribing for dental pain should be limited to short courses after failure of NSAIDs/acetaminophen; risks include dependence and diversion.

Drug interactions: azole antifungals inhibit CYP3A4; macrolides and metronidazole interact with warfarin, raising INR.

Pilocarpine and cevimeline are cholinergic sialagogues for xerostomia; contraindicated in uncontrolled asthma and narrow-angle glaucoma.

Dental caries: Streptococcus mutans and Lactobacillus species are key acidogenic/aciduric organisms; biofilm pH drop below 5.5 demineralizes enamel.

Periodontitis: Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola form the red complex; Aggregatibacter actinomycetemcomitans is associated with aggressive periodontitis.

Odontogenic infection spreads along fascial planes; Ludwig angina is bilateral submandibular/sublingual cellulitis with airway risk requiring urgent management.

Herpes simplex virus: primary infection causes herpetic gingivostomatitis; recurrent infection causes cold sores; reactivation triggered by stress, UV, and immunosuppression.

Varicella-zoster virus: reactivation causes shingles with dermatomal vesicles; Ramsay Hunt syndrome involves facial palsy and vesicles in the ear canal.

Human papillomavirus types 16 and 18 are associated with oropharyngeal squamous cell carcinoma; vaccination reduces risk.

Innate oral defenses include salivary IgA, lysozyme, lactoferrin, and epithelial barrier; saliva also contains histatins with antifungal activity.

Antibiotic stewardship: odontogenic infections are usually polymicrobial; culture and sensitivity are reserved for severe, recurrent, or nonresponsive cases.