Oral Pathology, Oral Medicine, and Systemic Conditions
What the exam tests
This domain tests pattern recognition and safe referral: which lesions are developmental, which are infectious, and which are systemic red flags.
Core rules
- Developmental: Epstein pearls and Bohn nodules need no treatment; eruption cysts self-resolve; natal and neonatal teeth are 85% mandibular incisors, with supernumerary teeth extracted and primary teeth retained if feeding is safe.
- Odontogenic: dentigerous cyst, odontoma (compound is most common), ameloblastic fibroma, and keratocyst in nevoid basal cell carcinoma syndrome (bifid ribs, palmar pits).
- Soft tissue: mucocele on the lower lip, ranula on the floor of the mouth, hemangioma with involution, lymphangioma.
- Infections: primary herpetic gingivostomatitis causes fever, vesicles and dehydration risk; also recurrent herpes labialis, candidiasis, hand-foot-mouth disease and herpangina.
- Systemic: endocarditis prophylaxis only for high-risk cardiac lesions; bleeding disorders need factor replacement or desmopressin; leukemia may present with gingival bleeding and ulceration.
Worked example
A 4-year-old has fever, drooling and multiple ulcers on the gingiva and tongue. Reasoning: primary herpetic gingivostomatitis. Treatment is supportive with hydration and analgesia; antibiotics are not indicated. Review in 48 hours for dehydration. If the child is immunocompromised, add aciclovir.
Traps
Excising a hemangioma; prescribing antibiotics for viral ulcers; missing a keratocyst syndrome; assuming every natal tooth is supernumerary.