Oral and Maxillofacial Pathology
Oral and Maxillofacial Pathology in the UK is a dental specialty. Responsibility for the dental specialties lies with the General Dental Council (GDC). The curriculum for specialist training programmes in Oral and Maxillofacial Pathology is approved by the GDC.
Overview and Introduction
The discipline of Oral and Maxillofacial Pathology is a clinical specialty, undertaken by laboratory-based dentists, that is concerned with the diagnosis and assessment of diseases of the oral and maxillofacial region. It is a branch of histopathology and, in common with medical histopathologists, oral and maxillofacial pathologists provide reports based on interpretation of tissue biopsies of varying types and of surgical resection material. The main method of examination of specimens is by light microscopy, but this is supplemented by other techniques as appropriate, such as immunohistochemistry, molecular analysis and electron microscopy. The majority of specialists are senior academics with honorary consultant status who are based in dental schools; however, there is a small number of specialists appointed to NHS posts in regional or district hospitals. Academic trainees, such as Lecturers, Academic Clinical Fellows (ACFs) and Academic Clinical Lecturers (ACLs), will need to obtain higher academic degrees related to proficiency in research, as well as specialist training in Oral and Maxillofacial Pathology.
The designation “oral pathology” has traditionally referred to all aspects of the pathology of the mouth and related tissues. This general description, which has remained unchanged for many years, reflected the academic and service responsibilities of most pathologists based within university dental schools. In recent years, there has been a significant increase in the scope and complexity of diagnostic work undertaken. This has arisen partly because of the range of surgery now undertaken by specialists in oral and maxillofacial surgery (OMFS), blurring of some boundaries between OMFS and ear, nose and throat (ENT) surgery, the development of head and neck cancer services and the trend for increasing specialisation within diagnostic histopathology.
It is the view of the Specialty that training in Oral and Maxillofacial Pathology should be sufficiently broad and detailed to allow successful trainees to apply for specialist posts in head and neck pathology in medical histopathology departments.
Please note that although the GDC and others recognise the name Oral and Maxillofacial Pathology as the name of the specialty, the Royal College of Pathologists remains in transition to the new name and the specialty may appear as Oral Pathology or Histopathology (Oral). These should be considered synonymous.
The recognised higher specialist qualification in Oral and Maxillofacial Pathology is the Fellowship of The Royal College of Pathologists (FRCPath), obtained by examination. As Oral and Maxillofacial Pathology is a dental specialty, formal recognition of the status of specialist oral and maxillofacial pathologists is the responsibility of the GDC and this allows inclusion of individuals on the Oral and Maxillofacial Pathology specialist list. The GDC delegates responsibility for the quality management of specialist training to Postgraduate Deaneries. The relevant Specialist Advisory Committee (SAC) will provide external advice when it is requested by Deaneries. Oral and Maxillofacial Pathology comes under the remit of the SAC in the Additional Dental Specialties (SAC ADS). The SAC for the Additional Dental Specialties is concerned with the four additional dental specialties; these are Oral Medicine, Oral and Maxillofacial Pathology, Dental and Maxillofacial Radiology, and Oral Microbiology.
The award of the FRCPath in Oral and Maxillofacial Pathology, by examination, to dentally qualified candidates is critical in maintaining the training and standards of Oral and Maxillofacial Pathology as the equivalent of all other branches of pathology. The conduct of examinations for Fellowship of The Royal College of Pathologists in Oral and Maxillofacial Pathology is the responsibility of The Royal College of Pathologists. Postgraduate Deaneries are responsible for the educational approval of Oral and Maxillofacial Pathology training programmes. From time to time, Deaneries may seek external advice from the SAC. Deanery approval and quality management of training programmes is essential and ensure that programmes meet the requirements for entry to the FRCPath examination. The GDC is responsible for the external quality assurance of specialty training managed by Postgraduate Deaneries. Specialty training programmes are locally managed by Training Programme Directors; these posts are Deanery appointments. All trainees are required to have a named Educational Supervisor who is responsible for ensuring that Workplace Based Assessments (WBAs) and appraisals are carried out.
The Postgraduate Deanery is responsible for the appointment of trainees to training programmes and is also responsible for the annual assessment of trainees through the Annual Review of Competency Progression (ARCP) process.
All candidates for specialist training in Oral and Maxillofacial Pathology in the UK and Ireland must have full, or be eligible for temporary, registration with the GDC. Candidates must have completed broad based training such as that achieved following two years of Dental Foundation Training and will normally have obtained the MJDF or MFDS examination (or equivalent) to mark the end of Foundation Training. Postgraduate Deaneries are responsible for the appointment of trainees to specialty training programmes and for drawing up detailed job descriptions and person specifications for each specialty training post. Posts are advertised nationally and appointed in open competition. Trainees in the dental specialties, including Oral and Maxillofacial Pathology, are allocated a National Training Number (NTN). In Oral and Maxillofacial Pathology, these training numbers are awarded in conjunction with the Lead Dean for the Additional Dental Specialties. The use of NTNs is associated with monitoring the workforce in England and Wales and this monitoring is done in collaboration with Scotland and Northern Ireland.
The current version of the full curriculum in Oral and Maxillofacial Pathology, published in May 2015, is available from the General Dental Council website in the area on how to apply for registration on a specialist list at URL:
The curriculum is an extensive document with a syllabus and outlines of training and assessments. In outline, it is expected that trainees will follow a structured training pathway with workplace based assessments for a period of four years minimum, with 5 years normally taken to complete all the requirements to be awarded the Certificate of Completion of Specialty Training (CCST) necessary for the local Postgraduate Dean to make a recommendation to the GDC for inclusion on the specialist list and to be eligible for a UK NHS Consultant post. At least one of those years must be in a general pathology environment; in practice the majority of UK trainees are linked into medical histopathology departments for much or all of their training.
It is expected that trainees will normally sit the FRCPath part 1 examination after 2½-3 years of training, including one in general histopathology, and the part 2 examination at around 4½-5 years of training.
Completion of training requires:
- Satisfactory completion of 60 months of training (whole-time equivalent) as determined by the Postgraduate Deanery responsible for training in conjunction with the Training Programme Director.
- Satisfactory completion of all areas of the curriculum as judged by a satisfactory ARCP outcome at the annual training review meetings undertaken by the Deanery and reported to the SAC and, at the end of training, completed the Annual Review of Competence Progression (outcome 6).
- A pass in Parts 1 and 2 of the FRCPath examination in Oral and Maxillofacial Pathology, as determined by the Royal College of Pathologists.
On completion of training and having satisfied 1-3 above, the local Postgraduate Dental Dean will sign off GDC form Rec 1 in order to recommend that the trainee be awarded a CCST and so be eligible for specialist listing
Note that you must hold FULL registration with the General Dental Council to be awarded a CCST. Ideally, overseas, non-EEA, non-UK trainees should have obtained full registration prior to entering specialty training so that working towards a CCST is not compromised by studying for the GDC Overseas Registration Exam (ORE) or equivalent exam.
The Part 1 is a written test of core knowledge. The examination will comprise two papers with a combination of short answer questions. There will be 11 questions on each paper, of which 8 must be answered per paper. All questions are equally weighted.
Paper 1 will cover general pathological principles and will include aspects of general histopathology relevant to oral and maxillofacial pathology. Paper 2 will be slanted to oral and maxillofacial pathology.
The Part 2 examination comprises practical and oral components taken over two days and is designed to test the capability of the candidate to be an independent specialist in diagnostic oral pathology.
The Part 2 examination is conducted in five sections (designated A, B, C, D and E) with specified objectives. Candidates must pass Section A in order to be eligible for a pass. The aggregation of the scores in the different parts of the examination and any compensation between parts is at the discretion of the three examiners, who will take into account the entire performance of the candidate over the two days in reaching their agreed final decision of pass or fail.
The objective of Section A is to test the candidate’s competence to diagnose a wide range of the lesions that might present to an oral pathologist, taking cognisance of the specifications in the above sections. Section A comprises not more than 20 cases for diagnosis and lasts three hours.
The objective of Section B is to test the ability of the candidate to report complex cases. Six cases will be used. These may include a large resection, cases with multiple biopsies or cases requiring special stains, immunocytochemistry or molecular biology investigations for diagnosis. Section B lasts three hours.
The objective of Section C is to test the candidate’s ability at specimen dissection, cut-up, selection and preparation of tissue blocks for histopathological examination. Candidates should expect to be required to dissect, at least partially, an appropriate resection specimen as well as smaller biopsy material. Section C lasts not more than 45 minutes.
The objective of Section D is to assess the candidate’s ability to communicate the results and interpretation of histopathological findings in the context of a consultation using a multi-headed microscope. Section D lasts not more than two hours.
Section E is the oral examination and should last not more than one hour. The subject matter of the oral examination may include any aspect of the examination. It also includes areas not covered earlier in the examination, such as health and safety, the regulatory framework of laboratory practice, responsibilities of consultants and aspects of laboratory management.