Oral Medicine
Oral Medicine
This domain tests diagnosis and management of mucosal, salivary, and medically related oral disease. The exam prioritizes chronicity, biopsy thresholds, and recognition of systemic connections.
Core rules
- Any ulcer persisting beyond two weeks, or any indurated or fixed lesion, needs biopsy or urgent referral.
- Leukoplakia is a clinical diagnosis; erythroplakia has a higher malignant transformation risk and requires biopsy.
- Oral lichen planus is usually bilateral and reticular; erosive lesions need biopsy to exclude dysplasia or malignancy.
- Candidiasis may reflect local or systemic immunosuppression; treat and investigate predisposing factors.
- Vesiculobullous disease such as pemphigus vulgaris or mucous membrane pemphigoid requires biopsy with direct immunofluorescence.
Worked example
A 60-year-old has a 6-week lateral tongue ulcer with induration and no clear traumatic cause. Reasoning: chronicity and induration are red flags for oral squamous cell carcinoma. Incisional biopsy is required; a trial of removal of local irritation is not appropriate. Imaging and neck assessment follow if malignancy is confirmed.
Traps
Reassuring a patient with a persistent ulcer; prescribing steroids before diagnosis; missing drug-related osteonecrosis; attributing all white patches to candidiasis; failing to examine the neck.