Kuwait Dental Board Oral & Maxillofacial Surgery common mistakes
Kuwait Dental Board Oral & Maxillofacial Surgery · Understand the traps and how to avoid them.
When asked to assess a medically complex patient before extraction, the candidate lists the diagnosis (e.g. 'controlled type 2 diabetic') and stops there, without translating it into a pre-operative HbA1c target, a morning-appointment/short-session plan, antibiotic or chlorhexidine considerations, or a post-operative review interval.
Candidates memorise disease names and drug classes but rehearse them as isolated facts rather than as a decision pathway from history to modification of treatment. Under oral examination pressure, recall defaults to the label instead of the plan, and the candidate assumes the examiner only wants the diagnosis.
What to do instead
Practise a fixed four-step verbal template for every systemic condition: (1) severity/control marker with a number, (2) the specific risk the procedure creates, (3) the concrete modification (timing, duration, haemostasis, drug interaction, monitoring), (4) the review/safety-net instruction. Rehearse it aloud for diabetes, anticoagulants, bisphosphonates, pregnancy, adrenal insufficiency and infective endocarditis until it is automatic.
On a panoramic or CBCT description, the candidate jumps straight to a diagnosis ('it's an ameloblastoma') without first giving a structured radiological description: location, size, borders, internal structure, effect on adjacent teeth and cortices, and expansion versus perforation.
The oral exam rewards a visible 'answer', so candidates skip the descriptive step they consider obvious or time-wasting. This is reinforced by written-exam habits where only the final diagnosis is marked, so the descriptive discipline was never practised.
What to do instead
Use a mandatory reporting sequence (Site, Size, Shape, Margins, Internal architecture, Effects on adjacent structures, Cortical integrity) before any interpretation, and finish with a short differential ranked by likelihood with the discriminating feature for each. Practise on ten anonymised images, saying the description aloud in under 60 seconds before naming a diagnosis.
When describing management of a spreading odontogenic infection, the candidate recommends incision and drainage plus antibiotics but omits airway assessment, the specific fascial spaces involved, the choice of anaesthetic/sedation setting, the need for culture and source control (extraction or pulpectomy), and the criteria for hospital admission.
Textbook revision is organised by space (submandibular, pterygomandibular) as anatomy rather than as a clinical severity algorithm. Candidates therefore reproduce anatomy correctly but never connect it to the decision of whether the patient can be safely treated in an outpatient setting.
What to do instead
Build a one-page severity ladder: trismus and floor-of-mouth elevation, dysphagia, voice change, stridor, systemic signs (fever, tachycardia, dehydration), and comorbidity. For each rung, state the setting, airway plan, drainage approach, antimicrobial rationale and review. Rehearse two contrasting vignettes (localised periapical abscess versus bilateral submandibular with floor-of-mouth involvement) so the escalation logic is explicit.
In a trauma scenario, the candidate describes reducing and fixing a mandibular fracture but does not perform or verbalise the primary survey (airway with cervical spine control, breathing, circulation, disability, exposure), does not state which imaging is required, and does not address concomitant injuries such as a condylar fracture on the opposite side or a cervical spine injury.
Maxillofacial trainees rehearse fracture classification and fixation methods, which are the 'interesting' content, and treat ATLS as background knowledge from another specialty. Exam pressure then triggers recall of the fixation hierarchy rather than the resuscitation sequence.
What to do instead
Answer every trauma question in two phases: 'first, ATLS primary and secondary survey with C-spine precautions, then...' and only afterwards the maxillofacial specifics. Keep a checklist of commonly missed companions (second condylar fracture, dentoalveolar segment, orbital floor with zygomatic complex, Le Fort level with airway risk) and state imaging (OM views, CT with axial and coronal reformats) explicitly.
When discussing a suspicious oral lesion, the candidate gives a differential and says 'biopsy' without specifying the type of biopsy, the site selection within the lesion, the avoidance of necrotic or heavily keratinised areas, the handling and transport of the specimen, and the timing of referral to a tertiary centre.
'Biopsy' is treated as a single generic action rather than a technique with decision points. Candidates also under-prepare for oral medicine/oncology because they perceive it as a smaller part of a surgical curriculum, so the detail was never learned to the depth an oral examiner expects.
What to do instead
Prepare a short script on incisional versus excisional versus brush cytology versus fine-needle aspiration, with indications for each, plus site selection rules (periphery including normal tissue, avoid ulcer base and keratotic crest), specimen orientation and fixation, and a two-week urgent referral pathway. Link it to the red-flag list (non-healing ulcer over three weeks, induration, fixation, lymphadenopathy, single neck node in an adult).
In local anaesthesia questions, the candidate states the maximum dose of lidocaine with adrenaline but cannot convert it into the number of cartridges for a given patient weight, cannot explain the rationale for the adrenaline concentration, and does not describe the sequence for managing a suspected intravascular injection or a progressing local anaesthetic systemic toxicity reaction.
Maximum doses are memorised as bare numbers (mg/kg) without practising the arithmetic or linking it to cartridge volume and concentration. Intralipid rescue and LAST management sit at the edge of the curriculum and are often skipped as 'rare'.
What to do instead
Drill the arithmetic: weight x mg/kg gives total mg; divide by mg per cartridge (e.g. 2% lidocaine = 36 mg in 1.8 mL) to get cartridge count; state the adrenaline ceiling separately. Then rehearse LAST as a timed sequence: stop injection, call for help, airway and 100% oxygen, benzodiazepine for seizures, lipid emulsion 20% bolus and infusion per weight, CPR if arrest, and prolonged observation.
When asked about surgical removal of a lower third molar, the candidate describes the flap and bone removal but omits the pre-operative assessment that determines difficulty and consent: radiographic relationship to the inferior alveolar canal, lingual plate thickness, root morphology, adjacent second molar status, and a documented discussion of nerve injury, dry socket, bleeding, trismus and jaw fracture risk.
Candidates focus on the operative steps because that is what they are most anxious about, and treat consent and risk communication as a formality. Difficulty scoring systems and canal proximity signs are learned in isolation and not integrated into a spoken plan.
What to do instead
Structure every exodontia answer as assessment (clinical plus radiographic signs of proximity, angulation, root form, bone density), difficulty grading, anaesthetic plan, surgical sequence, and a named risk list with mitigation and post-operative instructions. Practise explaining the risks to a lay person in plain language, including what to do if numbness persists.
In implantology questions, the candidate recommends an implant without stating the diagnostic workup and prosthetic-driven planning: bone volume and density assessment, ridge width measurement method, CBCT with a radiopaque stent or scan appliance, interarch space, opposing dentition, occlusal scheme, medical and smoking risk factors, and the loading protocol.
Implant discussion is often reduced to 'place a 4.0 x 10 mm fixture', because candidates have seen many cases and assume the planning is implicit. The examination, however, tests whether the candidate can articulate the decision chain, and the omission signals a technician's rather than a surgeon's understanding.
What to do instead
Answer with a fixed chain: patient factors and contraindications, clinical and radiographic assessment with measurements, prosthetic plan first (crown/implant angulation, emergence, occlusal clearance), surgical approach and graft decision, loading and review timeline. Quote numbers (minimum ridge width, safety margin from adjacent roots and nerves) rather than vague statements.
When asked to justify a clinical decision, the candidate answers with personal experience or a textbook assertion ('in my experience', 'it is well known that') instead of citing the level of evidence, the study design, or the guideline source, and cannot explain sensitivity, specificity, likelihood ratio, number needed to treat, or the difference between a systematic review and a narrative review.
Clinical training rewards confident assertion, and evidence-based practice is often examined as definitions rather than as applied appraisal. Candidates therefore learn terms passively and cannot deploy them when asked to defend a management choice.
What to do instead
For each major topic, prepare one landmark-trial or guideline citation with its design and main finding, and practise appraising one abstract per week using a fixed grid (design, population, intervention, comparator, outcome, bias, applicability). Be able to compute and interpret sensitivity, specificity, PPV/NPV and NNT from a simple 2x2 table, and to explain why PPV depends on prevalence.
In a medical emergency station, the candidate identifies the condition correctly (e.g. vasovagal syncope, hypoglycaemia, angina, anaphylaxis) but manages it in the wrong order: gives a drug before positioning and airway, fails to stop the procedure and remove the stimulus, does not call for help or assign roles, and does not state the observation period or the criteria for transfer to hospital.
Emergency algorithms are learned as drug lists rather than as sequences with a position-airway-help-drug-reassess hierarchy. Candidates also rehearse alone, so they never practise delegating or verbalising roles under time pressure.
What to do instead
Rehearse each emergency as a spoken drill with a stopwatch: recognise, stop treatment, position, airway and oxygen, call for help with named roles, then the specific drug and dose, then reassess and decide on discharge or transfer. Do this in pairs with one person acting as team leader, and include the recovery position, glucose measurement, adrenaline route and dose, and the 30-minute observation rule.