BDS Oral Medicine Syllabus

What syndrome links perioral/oral melanotic macules with intestinal polyposis?

Peutz-Jeghers syndrome (mucocutaneous pigmentation with hamartomatous GI polyps).

What is the diagnostic gold standard for a suspected oral malignancy?

Incisional (or excisional for small lesions) biopsy with histopathological examination.

What is the role of toluidine blue in oral diagnosis?

A vital stain that preferentially binds nucleic acids of dysplastic/malignant cells, used to highlight suspicious mucosal areas and guide biopsy site selection.

What is exfoliative cytology and its main limitation in oral diagnosis?

Collection of surface epithelial cells for microscopic study; its main limitation is that it samples only superficial cells and cannot reliably diagnose invasive dysplasia, so a positive/suspicious result requires biopsy confirmation.

Which imaging modality is best for evaluating soft-tissue extent of oral tumors and perineural spread?

Magnetic resonance imaging (MRI), due to its superior soft-tissue contrast.

What does cone-beam computed tomography (CBCT) provide over conventional radiography?

Three-dimensional imaging of hard tissues with relatively lower radiation than medical CT, useful for bony lesions, impactions, and implant planning.

What is the value of measuring salivary flow rate (sialometry) and a typical threshold for hyposalivation?

It quantifies salivary output to diagnose hyposalivation; unstimulated whole salivary flow $\leq 0.1\ \text{mL/min}$ (or stimulated $\leq 0.7\ \text{mL/min}$) indicates hyposalivation.

Define differential diagnosis in oral medicine.

A prioritized list of possible diseases that could account for a patient's clinical findings, refined through history, examination, and investigations to reach the definitive diagnosis.

For a solitary white patch that does not rub off, list a concise differential diagnosis.

Leukoplakia, frictional/traumatic keratosis, chronic hyperplastic candidiasis, lichen planus (plaque type), and early squamous cell carcinoma.

Give a differential diagnosis for bilateral white lesions of the buccal mucosa.

Lichen planus, lichenoid reaction, leukoedema, white sponge nevus, and chronic cheek biting (morsicatio buccarum).

What oral finding may be the first sign of leukemia?

Diffuse gingival enlargement/hyperplasia with spontaneous gingival bleeding, mucosal pallor, or ulceration.

How does iron-deficiency anemia manifest in the mouth?

Atrophic glossitis (smooth, bald tongue), angular cheilitis, pallor, and oral candidiasis; part of Plummer-Vinson syndrome with dysphagia.

What oral manifestations are associated with uncontrolled diabetes mellitus?

Periodontitis, xerostomia, oral candidiasis, delayed wound healing, and burning mouth/sensory changes.

Which oral lesions are strongly indicative of HIV infection/AIDS?

Oral hairy leukoplakia (EBV-related, lateral tongue), pseudomembranous candidiasis, Kaposi sarcoma, necrotizing periodontal disease, and aphthous-like ulcers.

What is the classification/color scheme of the ASA physical status system used for risk assessment?

ASA I (healthy), ASA II (mild systemic disease), ASA III (severe systemic disease, not incapacitating), ASA IV (severe disease that is a constant threat to life), ASA V (moribund), and ASA VI (brain-dead donor).

For a patient on warfarin needing minor oral surgery, what INR is generally considered safe to proceed without dose modification?

An INR $\leq 3.5$ (commonly stated as up to 4.0 for simple extractions) allows minor oral surgery with local hemostatic measures, without stopping warfarin.

What antibiotic prophylaxis guidance applies to patients at high risk of infective endocarditis before invasive dental procedures?

A single dose of amoxicillin $2\ \text{g}$ orally (clindamycin $600\ \text{mg}$ if penicillin-allergic) one hour before procedures involving gingival/periapical manipulation, only for high-risk cardiac conditions.

What is MRONJ and which drug classes cause it?

Medication-related osteonecrosis of the jaw: exposed necrotic bone >8 weeks in a patient on antiresorptive (bisphosphonates, denosumab) or antiangiogenic drugs, without prior head/neck radiation.

How should dental treatment be timed relative to hemodialysis for a patient with chronic kidney disease?

Treat on the day after dialysis, when the patient is not fluid-overloaded and heparin's anticoagulant effect has worn off.

What precaution regarding elective dental care applies after a recent myocardial infarction?

Defer elective care for at least 6 weeks (ideally until stable), minimize stress, use limited epinephrine, and ensure good pain/anxiety control.

What is the maximum recommended dose of lidocaine with epinephrine, and why does epinephrine raise it?

About $7\ \text{mg/kg}$ (up to $500\ \text{mg}$) with epinephrine versus $4.4\ \text{mg/kg}$ (300 mg) plain; the vasoconstrictor slows systemic absorption, reducing peak plasma levels.

What is the first-line topical treatment for symptomatic recurrent aphthous stomatitis or erosive lichen planus?

Topical corticosteroids (e.g., triamcinolone acetonide in orabase, or a corticosteroid mouthwash/gel).

Which antifungal agents are used topically versus systemically for oral candidiasis?

Topical: nystatin suspension or miconazole gel; systemic: fluconazole (drug interactions and resistance considered).

What are the first-line systemic drugs for trigeminal neuralgia?

Carbamazepine (first-line) and oxcarbazepine; alternatives include gabapentin, pregabalin, and baclofen.

Why is topical antifungal treatment preferred over systemic where possible, and what interaction limits miconazole use?

Topical therapy limits systemic exposure and adverse effects; miconazole potentiates warfarin (raising INR/bleeding risk) via CYP inhibition, so caution is required in anticoagulated patients.

Name non-pharmacological management strategies for xerostomia.

Frequent sips of water, sugar-free gum/lozenges to stimulate flow, salivary substitutes/gels, humidified air, avoiding caffeine/alcohol/tobacco, and meticulous oral hygiene with fluoride.

What non-drug therapies are used for temporomandibular disorders (TMD)?

Patient education/reassurance, soft diet and jaw rest, occlusal splints/stabilization appliances, physiotherapy and jaw exercises, thermal therapy, and cognitive behavioral therapy.

What is the role of low-level laser (photobiomodulation) therapy in oral medicine?

It is used to reduce pain and promote healing in oral mucositis, aphthous ulcers, and TMD, by modulating inflammation and stimulating cellular repair without thermal ablation.

What is pharmacogenomics and give an oral-medicine-relevant example.

The study of how genetic variation affects drug response; e.g., HLA-B*15:02 allele predicts carbamazepine-induced Stevens-Johnson syndrome, guiding screening before prescribing for trigeminal neuralgia.

How is genomic medicine applied to oral cancer risk and management?

Through identification of somatic mutations (e.g., TP53, CDKN2A), HPV status in oropharyngeal carcinoma, salivary/liquid biopsy biomarkers, and molecular profiling to guide targeted therapy and prognosis.

What is teledentistry and what are its two main modes of delivery?

The use of telecommunication and information technology to provide remote dental/oral healthcare; delivered by synchronous (real-time video consultation) and asynchronous (store-and-forward of images/records) methods.

State two key benefits and two limitations of telemedicine in oral health.

Benefits: improved access for remote/underserved patients and efficient triage/screening reducing unnecessary visits. Limitations: inability to perform tactile examination/palpation or biopsy, and dependence on image quality, connectivity, and data-privacy safeguards.