Oral Medicine, Oral Pathology and Oral Radiology
What the exam tests
Oral Medicine, Oral Pathology and Oral Radiology tests lesion recognition, red-flag triage, investigation choice, and radiological interpretation. The exam favours persistent lesions, potentially malignant disorders, and systemic disease.
Core rules
- Any ulcer persisting beyond 2–3 weeks, especially if indurated, fixed, or associated with lymphadenopathy, needs urgent referral and biopsy. Do not treat empirically with steroids or antifungals without review.
- Leukoplakia is a clinical diagnosis of a white patch that cannot be characterised otherwise; biopsy is needed to exclude dysplasia or malignancy. Erythroplakia carries a higher risk.
- Lichen planus is usually bilateral and reticular; unilateral erosive lesions need biopsy.
- In radiology, apply ALARA. Choose intraoral, panoramic, CBCT, CT, or MRI according to the question. Report systematically: image quality, anatomy, bone, teeth, sinuses, and incidental findings.
- Correlate radiographic findings with clinical examination; a radiolucency is not a diagnosis.
- Systemic causes of oral lesions include diabetes, HIV, anaemia, and medications.
Worked example
A 58-year-old smoker has a 2 cm painless, indurated ulcer on the lateral tongue present for 6 weeks, with a firm submandibular node. This is not recurrent aphthous stomatitis. The priority is urgent referral to oral and maxillofacial surgery for incisional biopsy and imaging. The reasoning is duration, induration, fixity, site, and lymphadenopathy, all red flags for squamous cell carcinoma.
Traps
- Reassuring a persistent ulcer without biopsy.
- Calling leukoplakia a histological diagnosis.
- Ignoring an incidental radiolucency.
- Using CBCT when MRI is better for soft tissue.