OMFS Board Exam Review #1 - Managing Medically Complex Patients | Anticoagulants, MRONJ, Free Flaps

Top 5 Topics:

- Managing dual antiplatelet therapy for dental extractions in patients with recent coronary stents.

- Handling diabetic patients with poor glycemic control requiring oral surgery.

- Evaluating MRONJ risk with oral vs. IV bisphosphonates, including cancer-related cases.

- Planning segmental mandibulectomy with fibula flap reconstruction after osteoradionecrosis.

- Preoperative coordination with oncologists, cardiologists, and plastic surgery—risk stratification done right.

*** I get answers and concepts wrong often! Please comment, DM me, or text me with any corrections, additions, or your own board prep tips on these topics so we can learn from my mistakes. ***

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Questions:

00:20 – Patient Evaluation: Recent coronary stents + dual antiplatelet therapy — extract or not?

01:45 – What to do with aspirin + clopidogrel in routine extractions?

03:20 – Hemostasis techniques: gel foam, figure-8 chromic gut, and post-op precautions

04:11 – Atrial fibrillation on warfarin: INR thresholds and when to proceed

07:53 – Diabetes Management: What HbA1c is too high for surgery?

09:45 – What blood glucose level is safe for routine extractions? ADA vs. Secrets vs. Boards

11:18 – Bisphosphonates: Oral vs. IV — When to worry about MRONJ?

16:54 – IV Bisphosphonates in cancer patients: acute infection, extraction urgency

19:30 – Stage 0 vs. Stage 1 MRONJ: How to classify this case?

21:27 – Osteoradionecrosis + pathological fracture: Segmental mandibulectomy planning

Now available on:

- Dr. Gallagher’s Podcast & YouTube Channel

- Dose of Dental Podcast

My watch in this episode = Citizen Promaster Diver Day Date

- 7.2025

References:

Reti, R., & Finlay, D. (2023). Oral Board Review for Oral and Maxillofacial Surgery.

Miloro, M., Ghali, G. E., Larsen, P. E., & Waite, P. (Eds.). (2022). Peterson’s Principles of Oral and Maxillofacial Surgery (4th ed.). Springer.

Abubaker, A.O., Lam, D., & Benson, K. (2016). OMFS Secrets (3rd ed.). Elsevier

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