Oral Medicine, Oral Pathology, and Oral Radiology
What this domain tests
This domain combines oral medicine, oral pathology, and radiology: recognising mucosal disease, deciding when to biopsy, interpreting images, and applying radiation protection.
Core rules
- An ulcer persisting beyond two to three weeks, or any indurated, fixed, or painless ulcer, needs referral and biopsy to exclude squamous cell carcinoma.
- Leukoplakia is a diagnosis of exclusion; remove the cause, photograph and map the lesion, and biopsy if it persists or shows non-homogeneous features.
- Oral lichen planus is usually bilateral, reticular, and managed with topical corticosteroids after biopsy where needed.
- Red flags for malignancy: smoking, alcohol, areca nut, previous head and neck cancer, unexplained bleeding, paraesthesia, and cervical lymphadenopathy.
- MRONJ: exposed bone for eight weeks in a patient on antiresorptives or antiangiogenics, with no metastasis or osteomyelitis; manage conservatively.
- Radiographs: describe site, size, shape, margins, internal structure, and effects on adjacent teeth and bone. Use rectangular collimation, lead apron, and ALARA.
Worked example
A 62-year-old with a 30 pack-year history has a 6-week lateral tongue ulcer, 2 cm, indurated and fixed, with no pain and no palpable nodes. Reasoning: malignancy must be excluded; the absence of pain does not reassure. Refer urgently for incisional biopsy and imaging; do not start a topical steroid trial.
Traps
Trying steroids on a chronic ulcer without biopsy; dismissing a lesion in a smoker as aphthous; ignoring a radiolucency because the tooth is asymptomatic.