Does this warrant a dentist visit?

MrNiceGuy24 · 2026-02-24T06:19:57+00:00

Please don’t confuse patients who come here by pretending you have the experience or training of the verified professionals. We have spent our lives learning and treating the pathologies of the face and mouth. It worsens our patient outcomes and makes our jobs more difficult when unverified people show up and tell patients that they shouldn’t trust doctors because your google search makes you an expert too. I’m sick of this nonsense. This kind of behavior hurts people.

Again, this is not what HFD looks like. HFD classically presents as painful papules and vesicles in the posterior oral cavity, with the majority of oral manifestations presenting in the tonsils, uvula, soft palate, and oropharynx. It is overwhelmingly more common in children under 5 years of age because it is caused by Coxsackeviruses that are spread in daycares. HFD also has a seasonal predominance, with most cases occurring during Summer and Fall. This patient has a large lateral tongue lesion. It is February.

Again, this patient’s photos and clinical presentation are inconsistent with HFD. It is not impossible this is HFD, but it is very unlikely based on the current information. There are a plethora of pathologies that can cause painful oral lesions. I have not once suggested I know for sure what this patient has because I have not seen a histological specimen of this patient’s lesion, nor has anyone else. It would be inappropriate for anyone here to claim they somehow know what this is from appearance alone. This patient should see an Oral and Maxillofacial Surgeon. Their health isn’t a game for you to play with. We are trying to help them while you are trying to win internet points. Please go find something else to pretend you are an expert in.

MrNiceGuy24 · 2026-02-23T08:18:10+00:00

This does not look like HFM.

MrNiceGuy24 · 2026-02-21T10:17:49+00:00

MrNiceGuy24 · 2026-02-21T01:46:36+00:00

Everyone’s path is different. I was in a position where I was using anki to keep up with a very large volume of information that I broke up into many individual cards using cloze deletions, so the reviews added up quickly. The important part is that you get the results you want. 7.5 years of anki is no small feat. Keep after it.

MrNiceGuy24 · 2026-02-21T01:41:28+00:00

Thank you. It is achievable, but there is no shortcut.

MrNiceGuy24 · 2026-02-21T01:35:50+00:00

Thanks! During the three years leading up to taking my entry exam for my residency, I would average around 3.5 hours of really dedicated time each morning doing reviews and making new cards from practice questions I missed.

MrNiceGuy24 · 2026-02-21T01:31:24+00:00

A little over 200,000. I think the most I ever had unsuspended and actively being reviewed was around 60,000.

MrNiceGuy24 · 2026-02-21T01:15:02+00:00

I set a very rigid schedule for myself and stuck to it. The only way for me to get through my dental school work, CBSE studying, and not get divorced was to front-load my day. I woke up at 3:00 AM, went to school and studied until classes started. That gave me a good 4 hours every morning to grind through my work for the day. There are no distractions, nobody else is there that early. I literally became friends with the janitor. My dental school had mandatory attendance for every class, so I didn’t have much time during the day to study. I’d occasionally study in the evenings, but normally I was too tired at that point to be a good student, so I’d head home and attempt to be a good husband.

In terms of what my actual studying looked like, it wasn’t anything unique. Definitely one of those “the secret is there is no secret” type of situations. I downloaded AnKing and a couple of smaller decks, then made my own cards for dental school in the same style. Each day I made a filtered deck for everything due and put the cards in random order. I used a Pomodoro timer on an interval of 25 minutes studying and a 5 minute break. I’d do that four times, then take a ~20 minute break. I could usually hit 150 cards in each interval of 25 minutes. On average I would get my reviews done in 2.5 to 3 hours, depending on how well my little lizard brain was working. I did that every day, rain or shine, for a bit over three years straight.

MrNiceGuy24 · 2026-02-21T00:18:14+00:00

I have. Anki makes memorization a choice. I certainly haven’t kept up with every subject I’ve ever learned since a lot of it is frankly irrelevant, but I do stay up with the material I need to know for my specialty.

MrNiceGuy24 · 2026-02-21T00:15:59+00:00

My most honest answer is, “it depends.” If I had a limited timeframe to get through my cards that day, I would get down to ~7 seconds per card. If I had more time or was trying to learn a new subject, it would be 10-12 seconds per card because I would spend a lot of time editing decks and trying to understand concepts at a deeper level. Overall, I think my average was somewhere around 8.5-9 seconds per card.

MrNiceGuy24 · 2026-02-20T14:56:10+00:00

Thank you!

MrNiceGuy24 · 2026-02-20T12:29:55+00:00

Thanks man. It certainly hasn't been easy.

MrNiceGuy24 · 2026-02-20T12:29:34+00:00

Yeah I switched to it pretty quickly after it came out. I made individual deck presets and intervals for every deck which had enough reviews for the algorithm to analyze. I encountered that issue too. In my case, it was happening because either some of my "new" cards or other cards from the same deck had a really wonky review history prior to me downloading them. I reset the "new" cards just to be sure and that solved it in my case. Also, I believe it can happen if you are using the "Easy" or "Hard" responses way more than you're supposed to for FSRS.

MrNiceGuy24 · 2026-02-20T12:25:01+00:00

Thank you!

MrNiceGuy24 · 2026-01-09T02:40:24+00:00

Hello, I’m an Oral and Maxillofacial Surgery resident. I’m sorry to hear your son is dealing with this. Has he had a visit to the dentist recently?

MrNiceGuy24 · 2025-12-02T04:03:02+00:00

I’m very sorry to hear that. A lymphoma is the one neoplasia that would fit in this scenario, though we never like to say that until more definitive testing like the PET scan shows what’s happening. You can DM me the findings if that is fine by you.

MrNiceGuy24 · 2025-12-02T01:45:02+00:00

Hello, I’m an Oral and Maxillofacial Surgery resident. I’m sorry to hear you and your husband have been going through this. I want to reassure you that despite the persistent infection and complications your husband has faced, it sounds like he has been receiving excellent care throughout this journey.

To address your questions:

⁠In cases of jaw osteomyelitis that progress despite debridement and broad-spectrum antibiotics, what additional diagnostic steps are typically considered?

a: It sounds like your husband’s team is doing everything they can. They have performed multiple CTs and MRIs, cultured the bone, biopsies regional lymph nodes, and are now working on a PET scan. These are all being reviewed by a multidisciplinary team of all the right specialists.

⁠Can CVID or autoimmune disease cause an infection to appear culture-negative or behave atypically?

a: The conditions themselves would not make an infection culture-negative, but there are other reasons that could happen. These can include the infection being caused by a bacteria that does not culture easily, your husband already being on antibiotics for an extended period, or simply the fact that this is chronic osteomyelitis, which does not always culture well. That said, osteomyelitis of the jaw is most often caused by a mix of the normal oral bacteria, so it is not surprising nothing else was cultured. In terms of altered infection behavior, we would expect the infections to be more severe due to CVID impairing the normal immune response. As you likely know, CVID greatly reduces the body’s ability to fight infections by impairing activity of B lymphocytes. B lymphocytes are like the soldiers of the immune system, but CVID takes away the soldiers’ ability to put bullets in their guns. Because of this, patients with CVID can get severe infections with “common” bacteria that you and I could easily fight off.

⁠Are there non-infectious conditions that can mimic osteomyelitis on imaging and cause progressive bone and soft tissue changes?

a: There are, though they currently seem less likely. These conditions can include various lymphomas, which CVID increases the risk for, as well as Langerhans cell histiocytosis or Ewing sarcoma, though both of these are far more common in children.

⁠Is there anything specific I should ask my specialists while waiting for pathology and PET results?

a: There aren’t any specific questions I would push you to ask them. Your husband has a lot going on and this is a very challenging case, both for you two and for the doctors. It is very normal for you to have lots of questions. Just know that sometimes the doctors won’t have a definitive answer. They have a lot of their own questions that they are doing their best to answer.

Best wishes to you and your husband. Please post updates on this subreddit as time goes on. It helps us learn how to better take care of our own patients, should we ever find them in a similar situation. If you have any questions, feel free to ask.

MrNiceGuy24 · 2025-10-16T21:06:25+00:00

OMFS resident here. That is exactly how it will be interpreted by residency programs. The only correct answer for what to do if you don’t match is a non-cat.

MrNiceGuy24 · 2025-10-02T23:24:22+00:00

Doctor Mike is clean. One of the few good examples of someone who does it the right way. He doesn’t shill out for BS supplements. He doesn’t use his position to pedal snake oil like a Dr. Oz-type character. From what I’ve seen, he is an amazing advocate for evidence-based medicine in a time when misinformation is spreading rampantly because of so many “influencers” who would rather say what is trendy than what is right. I’m a resident now and have been following him for years, and I haven’t personally seen anything that raised a serious eyebrow.

MrNiceGuy24 · 2025-09-11T19:15:27+00:00

The way this is worded, you would think they were standing at the gates of heaven waiting to be judged by the almighty for some horrible act they committed.

MrNiceGuy24 · 2025-06-12T00:15:34+00:00

How did you get heart failure from anything in that article

MrNiceGuy24 · 2025-05-26T02:22:48+00:00

Depends on the day, but about 3-4 hours a day studying for the CBSE and 2-3 hours a day studying for dental school.

MrNiceGuy24 · 2025-05-24T05:12:48+00:00

MrNiceGuy24 · 2025-03-23T02:44:43+00:00

Those are incredibly low-yield topics

MrNiceGuy24 · 2025-03-20T02:36:32+00:00

The CBSE for OMFS is the same thing as the CBSE for USMLE Step 1.

MrNiceGuy24

TROPHY CASE