General Medicine and General Surgery
What this domain tests
Recognition of systemic disease relevant to dental practice, safe modification of dental treatment, and the surgical principles shared with oral surgery.
Core rules
- Diabetes: HbA1c below 7% indicates good control; uncontrolled diabetes impairs wound healing and predisposes to periodontitis. Schedule morning appointments, and treat acute infection promptly.
- Hypertension: elective treatment is generally deferred with sustained values above 180/110 mmHg; check for drug interactions with vasoconstrictors in local anaesthetic.
- Infective endocarditis prophylaxis is now limited to the highest-risk cardiac conditions - prosthetic valves, previous infective endocarditis, certain congenital heart disease, and cardiac transplant with valvulopathy.
- Anticoagulants and antiplatelets: warfarin is guided by INR; direct oral anticoagulants are usually continued for minor procedures with local haemostasis. Never stop these without medical consultation.
- Asthma and epilepsy: have reliever inhaler or rescue benzodiazepine available; avoid triggering materials and stress.
- Surgical principles: asepsis, adequate anaesthesia, haemostasis, minimal tissue trauma, and closure without tension; wound healing proceeds through haemostasis, inflammation, proliferation and remodelling.
Worked example
A patient with a mechanical mitral valve needs a dental extraction. Reasoning: this is a highest-risk cardiac condition, so antibiotic prophylaxis is indicated - a single dose before the procedure according to national guidance - and warfarin is continued if the INR is within range.
Traps
- Giving prophylaxis for a prosthetic hip or a mitral valve prolapse without regurgitation.
- Stopping warfarin routinely before extractions.
- Treating a hypertensive patient at 200/120 mmHg electively.