Overseas Registration Exam (ORE) Oral Surgery, Oral Medicine and Pathology Syllabus

Oral Surgery, Oral Medicine and Pathology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Oral Surgery, Oral Medicine and Pathology in Overseas Registration Exam (ORE), not a summary of it.

1. 1

   Exodontia and Minor Oral Surgery

   4 topics

   • Assessment and Treatment Planning for Extractions
     • Indications, contraindications and consent
     • Radiographic assessment and proximity to vital structures
   • Surgical Technique
     • Forceps and elevator principles
     • Flap design, bone removal and suturing
   • Impacted Third Molars
     • NICE guidance on removal vs retention
     • Inferior alveolar and lingual nerve risk
   • Surgical Complications
     • Haemorrhage, dry socket and oro-antral communication
     • Fractured roots and displaced teeth
2. 2

   Orofacial Infections and Their Management

   4 topics

   • Odontogenic Infections
     • Spread of infection and fascial spaces
     • Ludwig's angina and airway emergencies
   • Antimicrobial Prescribing
     • Indications and antimicrobial stewardship
     • Dental antibiotic prophylaxis and endocarditis (NICE)
   • Pericoronitis and Acute Soft Tissue Infections
   • Osteomyelitis and Medication-Related Osteonecrosis of the Jaw
3. 3

   Oral Medicine and Mucosal Disease

   5 topics

   • Oral Ulceration
     • Recurrent aphthous stomatitis
     • Ulcers of systemic and traumatic origin
   • White and Red Lesions
     • Lichen planus and lichenoid reactions
     • Leukoplakia, erythroplakia and dysplasia
   • Vesiculobullous Disorders
   • Salivary Gland Disorders and Dry Mouth
   • Orofacial Pain and Neuropathic Conditions
4. 4

   Oral and Maxillofacial Pathology

   4 topics

   • Odontogenic Cysts and Tumours
     • Radicular, dentigerous and odontogenic keratocysts
     • Ameloblastoma and odontomes
   • Oral Cancer
     • Risk factors, presentation and staging
     • Urgent referral pathways and biopsy principles
   • Bone Pathology of the Jaws
   • Potentially Malignant Disorders and Surveillance
5. 5

   Maxillofacial Trauma

   3 topics

   • Dentoalveolar Trauma and Dental Avulsion Management
   • Mandibular and Mid-Face Fractures
   • Soft Tissue Injuries and Initial Assessment

Oral Surgery, Oral Medicine and Pathology flashcards for Overseas Registration Exam (ORE)

23 of 51 cards from the Oral Surgery, Oral Medicine and Pathology deck — real questions with worked answers.

1. What patient and tooth factors increase the predicted difficulty of a dental extraction during pre-operative assessment?

   Tooth factors: root number/curvature, hypercementosis, ankylosis, isolated standing teeth, heavily restored/root-filled (brittle) crowns, dense surrounding bone. Patient factors: limited mouth opening, anxiety, bleeding disorders, anticoagulants, bisphosphonate/antiresorptive use, radiotherapy, diabetes, immunosuppression and increasing age (denser bone).

2. List the key elements of informed consent that must be discussed before a surgical extraction.

   Nature of the procedure, expected benefits, risks/complications (pain, swelling, bruising, bleeding, infection, dry socket, nerve injury, sinus communication, fracture), realistic alternatives (including no treatment), anaesthetic options, and giving the patient opportunity to ask questions, all documented.

3. For lower third molars, which two nerves are at risk and what radiographic signs warn of inferior alveolar nerve (IAN) proximity?

   Inferior alveolar nerve and lingual nerve. High-risk panoramic signs: darkening/banding of the root, deflection of the root, narrowing of the root, interruption/loss of the white cortical lines of the canal, diversion of the canal, and narrowing of the canal. A CBCT is indicated when these signs are present.

4. Describe the standard three components of a surgical flap design for a buried tooth and the principle governing flap base width.

   Components: a sound mucoperiosteal flap with a relieving incision, raised to expose bone. Principle: the base of the flap must be wider than its free margin to preserve blood supply, margins should rest on sound bone after closure, and the flap should give adequate access while protecting adjacent structures.

5. What is the recommended method of bone removal and tooth sectioning in a surgical extraction, and why is irrigation essential?

   Bone removal with a round/fissure tungsten-carbide bur in a saline-cooled handpiece (not an air-driven turbine, to avoid surgical emphysema), with copious sterile saline irrigation to prevent thermal necrosis of bone (osteonecrosis occurs above approximately $47^{\circ}\mathrm{C}$). Teeth are sectioned to create a smaller removal path and reduce bone removal.

6. Give the Pell and Gregory and Winter classifications used to describe impacted mandibular third molars.

   Winter's classification = angulation relative to the second molar: mesioangular, distoangular, vertical, horizontal (also buccal/lingual, transverse). Pell & Gregory = depth relative to occlusal/cervical line (A, B, C) and relationship to anterior border of ramus / amount of space (Class 1, 2, 3).

7. According to NICE guidance, when is prophylactic removal of asymptomatic, disease-free impacted third molars indicated?

   It is NOT indicated. NICE recommends against routine prophylactic removal of pathology-free impacted wisdom teeth. Removal is justified only with pathology such as recurrent pericoronitis, unrestorable caries, cysts/tumours, fracture in line of the tooth, resorption of adjacent teeth, or infection.

8. What is a dry socket (alveolar osteitis): timing, cause, and presentation?

   Localised osteitis from premature loss/breakdown of the blood clot, typically presenting 3–4 days post-extraction. Features: severe throbbing pain radiating to the ear, empty socket with exposed bone, bad taste/halitosis, no pus. Risk factors: mandibular molars, smoking, oral contraceptives, traumatic extraction, poor oral hygiene.

9. How is alveolar osteitis (dry socket) managed?

   Irrigate the socket with warm saline/chlorhexidine to remove debris, then place an obtundent antiseptic dressing (e.g. Alvogyl / zinc oxide-eugenol pack), give analgesia and reassurance, and review. Antibiotics are not routinely required as it is not a true infection.

10. What are the signs of an oro-antral communication (OAC) and how does management differ by size?

    Signs: bubbling of blood at the socket, positive nose-blow (Valsalva) test, air/fluid passing to nose, bone at the trifurcation of an upper molar root on the extracted tooth. Management: small defects (<2 mm) may heal spontaneously; larger ones need surgical closure with a buccal advancement (or palatal/Rehrmann) flap, antibiotics, and nose-blowing precautions.

11. What are the cardinal local signs and the systemic features distinguishing a spreading odontogenic infection (cellulitis) from a localised abscess?

    Localised abscess: fluctuant, well-defined swelling, pus collection. Spreading cellulitis: diffuse, firm/indurated, ill-defined, erythematous, hot swelling with systemic upset (fever, malaise, raised WCC/CRP, tachycardia). Cellulitis represents diffuse soft-tissue spread before pus localises.

12. What is Ludwig's angina and why is it an airway emergency?

    A rapidly spreading bilateral cellulitis of the submandibular, sublingual and submental spaces, usually of odontogenic origin. It elevates and displaces the tongue, causes a firm 'bull neck', dysphagia and drooling, and can obstruct the airway. It is a surgical emergency requiring airway protection, IV antibiotics, and urgent surgical drainage.

13. State the core surgical principles for managing a fascial space odontogenic infection.

    Remove the source (extraction or drainage via the tooth), incise and drain pus (incision in dependent position, blunt dissection, drain placement), send pus for culture/sensitivity, give appropriate antibiotics, support with analgesia/hydration, and protect the airway. 'Remove the cause and drain the pus' is the guiding principle.

14. What are the first-line antibiotics for a spreading dental infection in a non-penicillin-allergic adult per UK guidance?

    Amoxicillin (or phenoxymethylpenicillin) is first line; metronidazole is added or used for anaerobic involvement. In penicillin allergy, clarithromycin (or metronidazole) is used. Antibiotics are an adjunct to operative drainage, never a substitute.

15. What general principles govern antimicrobial prescribing in dentistry to support antibiotic stewardship?

    Only prescribe when there is clear evidence of spreading infection or systemic involvement; manage localised infection by local operative measures (drainage, extraction, pulp extirpation); use the narrowest effective spectrum, correct dose and shortest course; and review. Most acute dental conditions need a procedure, not an antibiotic.

16. What is pericoronitis, which tooth is most commonly affected, and what are its features?

    Inflammation of the soft tissue (operculum) overlying a partially erupted tooth, most often a lower third molar. Features: pain, swelling, trismus, bad taste, pus discharge from under the operculum, halitosis, and possible trauma from the opposing upper molar biting on the inflamed flap.

17. How is acute pericoronitis managed conservatively?

    Irrigate under the operculum with warm saline or chlorhexidine, debride debris, relieve occlusal trauma (grind or extract the over-erupting upper third molar), advise hot salt-water mouthrinses and analgesia. Antibiotics (metronidazole/amoxicillin) only if spreading infection/systemic features. Definitive treatment may be extraction once acute episode settles.

18. Define osteomyelitis of the jaw and state the most commonly affected jaw and predisposing factors.

    An inflammatory infection of bone and marrow, more common in the mandible (poorer blood supply than the maxilla). Predisposing factors: odontogenic infection, trauma/fracture, diabetes, immunosuppression, smoking, alcoholism, and conditions reducing vascularity (e.g. radiotherapy, Paget's disease).

19. What is the SAC (or AAOMS) staging concept and definition of Medication-Related Osteonecrosis of the Jaw (MRONJ)?

    MRONJ is defined by: (1) current/previous treatment with antiresorptive (bisphosphonates, denosumab) or antiangiogenic drugs, (2) exposed bone or bone probed through a fistula in the maxillofacial region persisting >8 weeks, and (3) no history of radiation therapy or metastatic disease to the jaws.

20. According to SDCEP, how is MRONJ risk stratified and what is the key preventive strategy before starting antiresorptive therapy?

    Lower risk: osteoporosis patients on oral/IV bisphosphonates or denosumab <5 years without other risk factors. Higher risk: cancer patients on antiresorptives/antiangiogenics, or treatment >5 years, or concurrent steroids. Prevention: complete dental assessment and necessary extractions/oral surgery, and stabilise oral health, BEFORE commencing therapy.

21. Compare a recurrent aphthous stomatitis minor ulcer with a major aphthous ulcer.

    Minor aphthae: <10 mm, shallow, round/oval, non-keratinised mucosa, heal in 7–14 days without scarring. Major aphthae: >10 mm, deeper, last weeks to months, may scar, often affect keratinised mucosa too. Both spare keratinised gingiva/hard palate typically and recur.

22. List systemic/haematinic causes that should be excluded in a patient with recurrent oral ulceration.

    Deficiency of iron, folate or vitamin $\ce{B12}$; coeliac disease; Crohn's disease/ulcerative colitis; Behçet's disease; HIV; haematological disorders; and drug causes (e.g. nicorandil, NSAIDs, methotrexate). Investigate persistent or atypical ulceration with FBC and haematinics.

23. What is the single most important red flag for any oral ulcer and the rule about persistence?

    A solitary ulcer (often with rolled/indurated raised margins, bleeding, fixation to deep tissues) that fails to heal within 3 weeks must be regarded as oral squamous cell carcinoma until proven otherwise and referred urgently (2-week-wait) for biopsy.

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