Oral Medicine
This page contains the documents that relate to the Dental Specialty Fellowship Examinations for this topic.
- Examination Syllabus
- Assessment strategy
- Link to the GDC Curriculum
- Link to the training syllabus defined by the Specialty Advisory Committee (SAC)
- Illustration of how the change to the curriculum impacts the examination certifications
- Part 1 SBA Sample Questions
Examination Syllabus
Assessment Strategy
GDC Curriculum and Training Syllabus
Illustrative Examination Route
The images below image is to illustrate the changes to certification as a result of the introduction of the new curriculum. The illustration assumes full time training. Trainees on the NTN pathway should refer to their TPD’s or Post Graduate Dental Dean for information about progression.
Sample Questions
Below are five sample Single Best Answer (SBA) questions selected from across the syllabus. These questions are designed to be indicative of the level, style, and cognitive demand of the examination and reflect the use of higher‑order clinical reasoning. They are provided solely as a guide and should not be interpreted as representative of the full breadth or specific content of the assessment.
You will be required to select the most appropriate answer from a choice of five answers. There may be images and/or test results included in the data provided for the question.
The examination comprises two papers of 90 SBA questions, each of two hours’ duration. There is no negative marking, and candidates are therefore encouraged to attempt every question. During each paper, candidates will be able to navigate freely between questions and amend their answers at any point prior to submission. Further information on the in-centre assessment experience will be made available on the website and in direct communications to registered candidates.
A 71-year-old woman has painful desquamative gingivitis and intact buccal bullae. Nikolsky sign is positive. She uses no new medications. Malignancy is not suspected.
What is the most appropriate diagnostic investigation?
A. Biopsy of the ulcerated gingiva to include a bulla, and placing of the tissue in formalin
B. Patch testing for dental materials
C. Routine histology and perilesional biopsy for direct immunofluorescence
D. Exfoliative cytology (Tzanck smear) from the bulla
E. Serum ELISA for desmoglein 1 and 3 antibodies
The correct answer is C.
Justification: Desquamative gingivitis with oral bullae suggests an immune-mediated vesiculo, ullous disorder, particularly mucous membrane pemphigoid or pemphigus vulgaris. Diagnosis requires clinicopathological correlation.
Routine histopathology is useful, but direct immunofluorescence is often critical. The biopsy for immunofluorescence should be taken from perilesional, non-ulcerated mucosa because ulcerated tissue may lose diagnostic immune deposits and produce false-negative results. A second lesional biopsy in formalin allows assessment of the level of epithelial split and inflammatory pattern.
In mucous membrane pemphigoid, direct immunofluorescence typically shows linear deposition of IgG, IgA, or C3 along the epithelial basement membrane zone.
A 66-year-old patient has brief electric-shock facial pains in the right V2 distribution that are triggered by toothbrushing. Neurological examination is normal. Dental examination and radiographs are unremarkable.
What is the most appropriate initial management?
A. Arrange for a full oral and dental examination, particularly of the most heavily restored teeth
B. Prescribe opioids for breakthrough pain
C. Start amitriptyline and avoid neuroimaging
D. Start carbamazepine or oxcarbazepine and arrange MRI brain/trigeminal pathway
E. Start gabapentin as first-line therapy and refer for microvascular decompression surgery
The correct answer is D.
Justification: This presentation is typical of trigeminal neuralgia: unilateral, brief, electric-shock-like paroxysms in a trigeminal distribution, triggered by innocuous stimuli such as toothbrushing. Dental pathology should be excluded, but irreversible dental treatment is inappropriate when clinical and radiographic assessment are negative. Carbamazepine or oxcarbazepine is first-line pharmacological treatment. MRI is recommended to identify secondary causes such as cerebellopontine angle tumour, multiple sclerosis, or structural compression, and to support subsequent neurosurgical planning if medication fails.
A 59-year-old woman with established Sjogren’s disease reports persistent unilateral parotid enlargement, night sweats, weight loss and new cervical lymphadenopathy. Xerostomia has been stable for years.
What is the most appropriate next step?
A. Arrange minor salivary gland biopsy
B. Prescribe pilocarpine and review in three months
C. Reassure that parotid swelling is expected in Sjogren’s disease and does not need treatment unless symptomatic
D. Start systemic corticosteroid therapy for presumed Sjogren’s disease flare up
E. Urgently refer for suspected salivary gland lymphoma assessment
The correct answer is E.
Justification: Sjogren’s disease is associated with an increased risk of non-Hodgkin lymphoma, particularly mucosa-associated lymphoid tissue lymphoma. Persistent unilateral salivary gland enlargement, lymphadenopathy, and constitutional B symptoms, are concerning features.
Stable sicca symptoms alone can be managed supportively, but new persistent unilateral parotid swelling with systemic symptoms requires urgent specialist evaluation, imaging and tissue diagnosis where indicated.
A 55-year-old patient, who is a smoker, has a persistent adherent white plaque at the left commissure, extending onto the buccal mucosa. It does not wipe off. Antifungal therapy improves soreness, but the plaque persists.
What is the most appropriate next step?
A. Biopsy the white plaque
B. Perform oral exfoliative cytology
C. Prescribe steroid mouthwash to be used three times daily for three months
D. Reassure, give smoking cessation advice and discharge
E. Repeat empirical antifungal therapy up to four times at three-week intervals
The correct answer is A.
Justification: Chronic hyperplastic candidosis presents as a persistent non-scrapable white plaque, often at the commissures or buccal mucosa, especially in smokers. Candida may be present as a superinfection, but persistent keratosis after antifungal therapy requires biopsy because epithelial dysplasia or carcinoma can coexist or mimic the lesion.
A patient with suspected pemphigus vulgaris requires oral biopsy. The planned biopsy site is fragile perilesional buccal mucosa. The clinician wants to minimise epithelial separation artefact.
Which local anaesthetic technique is most appropriate?
A. Apply topical anaesthetic and biopsy without infiltration
B. Block injection submucosally immediately adjunct to the lesion
C. Inject directly into the lesional epithelium until blanching occurs
D. Inject intralesional injection beneath the blister
E. Use regional block or distant infiltration, avoiding the biopsy site
The correct answer is E.
Justification: Biopsy of fragile vesiculobullous mucosa requires careful technique. Injecting directly into the biopsy site can cause tissue distortion, mechanical epithelial separation, or artefact that compromises histopathological interpretation.
A regional block or infiltration placed away from the biopsy field provides anaesthesia while preserving the diagnostic architecture. Biopsy should include appropriate tissue for routine histology and, when autoimmune blistering disease is suspected, perilesional tissue for direct immunofluorescence in the correct transport medium.
