How can I prepare for the oral surgery board exam?

Preparing for the Oral Surgery Board Examination

Focus your preparation on mastering structured clinical scenarios, infection control protocols, and medication-related complications, as these form the core content areas tested by the American Board of Oral and Maxillofacial Surgery (ABOMS).

Understanding the ABOMS Examination Structure

The ABOMS administers the Oral Certifying Examination as part of its certification process, which has been serving the specialty since 1946 1. The examination committee creates, validates, and delivers examination content through volunteer directors who are experienced diplomates 1.

Key Content Areas to Master

Infection Control and Surgical Protocols

You must demonstrate comprehensive knowledge of infection control standards, as these are fundamental to safe oral surgical practice.

• Master the use of personal protective equipment (PPE) including sterile surgeon's gloves for all oral surgical procedures 2
• Understand proper hand hygiene protocols, including surgical hand antisepsis using antimicrobial products before donning sterile gloves 2
• Know the requirements for sterile saline or sterile water as coolant/irrigant during oral surgical procedures, using devices specifically designed for delivering sterile irrigating fluids 2
• Be prepared to discuss proper handling of biopsy specimens in sturdy, leakproof containers labeled with biohazard symbols 2
• Understand disposal protocols for extracted teeth as regulated medical waste, with special considerations for teeth containing amalgam 2

Medication-Related Osteonecrosis of the Jaw (MRONJ)

MRONJ represents a critical complication affecting 1-9% of cancer patients on bone-modifying agents, and you must know both prevention and management strategies.

Diagnosis Criteria

Confirm all three criteria for MRONJ diagnosis 2:

1. Current or previous treatment with bone-modifying agents (BMAs) or angiogenic inhibitors
2. Exposed bone or bone probeable through intraoral/extraoral fistula persisting >8 weeks
3. No history of radiation therapy to jaws or metastatic disease to jaws

Prevention Strategies

• Coordinate comprehensive dental, periodontal, and oral radiographic examination before BMA initiation in non-urgent settings 2
• Address modifiable risk factors including poor oral health, invasive dental procedures, ill-fitting dentures, uncontrolled diabetes, and tobacco use 2
• Avoid elective dentoalveolar surgical procedures (extractions, alveoloplasties, implants) during active BMA therapy at oncologic doses 2
• If dentoalveolar surgery is performed, evaluate patients every 6-8 weeks until full mucosal coverage occurs 2

Staging and Management

• Use established staging systems (2014 AAOMS, CTCAE 5.0, or 2017 International Task Force) consistently throughout patient care 2
• Staging should be performed by clinicians experienced with MRONJ management 2
• Initial treatment uses conservative measures: antimicrobial mouth rinses, antibiotics when indicated, effective oral hygiene, and removal of superficial bone spicules 2
• Aggressive surgical interventions (mucosal flap elevation, block resection) are reserved for refractory MRONJ with persistent symptoms 2

Antibiotic Prophylaxis Controversies

Understand that routine pre-dental procedure antibiotics for prosthetic joint infection prevention are NOT supported by current evidence.

• Prosthetic joint infections occur in <1% of patients 2
• Antibiotics cause adverse events requiring medical attention in 20% of patients, including allergic reactions, diarrhea, and Clostridioides difficile infection 2
• Only 12% of patients may warrant prophylaxis according to AAOS/ADA 2016 guidance, and this decision should be made by the orthopedic surgeon, not the dentist 2
• The orthopedic surgeon should write the prescription when prophylaxis is deemed appropriate 2

Effective Preparation Strategies

Structured Clinical Scenarios

Practice with scenario-based examinations that mirror the actual board format, as this approach has been validated by multiple specialty boards.

• Participate in mock oral examinations conducted in front of faculty and peers, which demonstrate high satisfaction rates (4.8/5.0 for examinees) and improve pass rates 3
• Focus on structured scenarios covering history-taking, diagnostic workup, laboratory/imaging interpretation, and treatment planning 4
• Treatment planning represents the area with the highest error rates among examinees, so dedicate extra preparation time here 4

Hands-On Experience

• Seek opportunities for cadaver-based training using advanced embalming techniques that preserve tissue quality for realistic surgical practice 5
• Practice dissection of soft and hard tissue, implantological procedures, and exposure of critical anatomical structures including maxillary sinus membrane, mucosa, bone, and nerves 5

Systematic Knowledge Review

• Review infection control guidelines comprehensively, including sterilization protocols for critical and semicritical instruments 2
• Master the management of patients on immunosuppressive therapy and understand coordination of care between dental and medical teams 2
• Study proper handling of multidose vials, single-use devices, and parenteral medications 2

Common Pitfalls to Avoid

• Do not recommend routine antibiotic prophylaxis for prosthetic joint patients without specific high-risk indications 2
• Never perform elective dental implants or extractions on patients receiving oncologic-dose BMAs 2
• Avoid relying solely on radiographic signs for MRONJ diagnosis without clinical confirmation of exposed bone 2
• Do not fail to coordinate care between dental and oncology teams before initiating BMA therapy 2
• Never reuse or resterilize single-use gloves or devices 2

Additional Resources

The American Board of Orthodontics offers "The Pathway Program" with virtual and live presentations for examination preparation, which may provide useful insights into board examination formats 6. Consider reviewing similar resources specific to oral and maxillofacial surgery if available through ABOMS.