Oral Medicine and Radiology
Oral Medicine and Radiology tests diagnosis of mucosal, salivary, and temporomandibular disorders, plus interpretation of intraoral and panoramic images. The emphasis is on pattern recognition and safe referral.
Core rules
- Oral lichen planus often presents as bilateral reticular white striae, sometimes with erosions; biopsy is needed for erosive lesions.
- Recurrent aphthous ulcers are painful, shallow, and heal without scarring; major aphthae are larger and may scar.
- Squamous cell carcinoma should be suspected in a nonhealing ulcer with induration, fixation, or lymphadenopathy.
- Panoramic radiograph shows the mandibular canal, maxillary sinus, and impacted teeth but has magnification and ghost images.
- CBCT gives three-dimensional bone detail with higher radiation than panoramic imaging.
Worked example
A 50-year-old has bilateral white striae on the buccal mucosa, painful erosions, and a history of hepatitis C. The likely diagnosis is oral lichen planus. Bilateral symmetry and reticular striae favor lichen planus; hepatitis C is associated with lichen planus. Because erosions are present, biopsy and follow-up are needed to exclude dysplasia or malignancy.
Traps
- A white patch that wipes off is more likely candidiasis than leukoplakia.
- Radiographic radiolucency of the lamina dura can be an early sign of periapical disease but is not always present.
- Do not diagnose trigeminal neuralgia from dental pain alone; trigger zones and electric shocks are characteristic.
- Panoramic images are not ideal for fine caries detection.