Oral surgery

Question 1

A fit and healthy patient presents to the surgery to have the surgical removal of the lower right third permeant molar (48).

1. Anatomically, which nerves must be anaesthetised to remove this tooth safely? (3 marks)

Answer 1

1) Right inferior alveolar nerve

2) Right lingual nerve

3) Right long buccal nerve

Question 2

A fit and healthy patient presents to the surgery to have the surgical removal of the lower right third permeant molar (48).

List TWO different ways you could assess that anaesthesia has been achieved? (1 mark)

Answer 2

ASK the patient if the right half of their tongue/lip/chin is numb

CHECK by probing adjacent to the 48 buccal/lingual

Question 3

After a 48 extraction the patient presents one week later with neuro-sensory deficit affecting the right chin and lip region. Using the descriptions below provide the dental terminology. (3 marks)

i) pins and needles feeling, or partial loss of sensation:

ii) painful, unpleasant or neuralgic sensation that lasts for a fraction of a second:

iii) total loss of sensation

Answer 3

i) Paresthesia

ii) Dysesthesia

iii) Anesthesia

Question 4

Give THREE clinical reasons that could account for neuro-sensory deficit during a 48 extraction (3 marks)

Answer 4

Crushing (1 mark)

Cutting (1 mark)

Damage to the nerve from the local anesthetic (1 mark)

Question 5

A patient returns to the clinic with symptoms and signs of a dry socket.

What is the correct terminology for this? (1 mark)

Answer 5

Alveolar osteitis

Question 6

List THREE predisposing factors that could contribute to dry socket? (3 marks)

Answer 6

Smoking (1 mark)

Sex: Female (1 mark)

More common to occur in molar extractions and more likely to occur in the mandible (1 mark)

Question 7

How would you manage dry socket (3 marks)

Answer 7

Supportive: reassurance and analgesics (1 mark)

LA, irrigate socket with warm saline, curettage and debridement (1 mark)

Antiseptic pack with Alvogyl (1 mark)

Question 8

Following clinical investigation, the coronal tooth structure of all the remaining teeth is found to be extensively decayed and therefore deemed unrestorable.

How would you manage these teeth given that that Mr Clarke is at an increased risk of osteoradionecrosis? (1 mark)

Answer 8

Provide primary orthograde endodontics and decoronate (1 mark)

Question 9

List ONE management strategy for established osteoradionecrosis of the jaw? (1 mark)

Answer 9

HBOT: hyperbaric oxygen therapy

Question 10

What type of handpiece is used for bone removal? (1 mark)

Answer 10

Electrical straight handpiece with saline cooled bur (1 mark)

Question 11

What are TWO aims for raising a flap in oral surgery? (2 marks)

Answer 11

To gain maximal access to underlying structures and tissues (1 mark)

To protect the surrounding soft tissues by reducing trauma to them (1 mark)

Question 12

What are 4 factors that influence flap design in oral surgery?

Answer 12

Aim of the surgical procedure (1 mark)

Condition of the surrounding tissues (1 mark)

Location of the surgical site (1 mark)

Wound healing (1 mark)

Question 13

What are 3 methods of achieving hemostatic control (3 marks)

Answer 13

Even and firm pressure (1 mark)

Suturing (1 mark)

LA with adrenaline (1 mark)

Question 14

List FOUR peri-operative complications (4 marks)

Answer 14

Fracture of tooth/root

Dislocation of TMJ

Damage to soft tissues

Damage to adjacent teeth

Question 15

A patient has had radiotherapy to the parotid gland. What are complications of extractions for this patient and why? (2 marks)

Answer 15

Increased risk of infection due to compromised immune system (1 mark)

Risk of osteoradionecrosis due to weakened bone tissue and delayed healing (1 mark)

Question 16

A patient comes in for a surgical extraction of roots 45. What nerves are needed to be anesthetized (2 marks)

Answer 16

Right inferior alveolar nerve (1 mark)

Right lingual nerve (1 mark)

Question 17

What are THREE possible nerve deficits (3 marks)

Answer 17

Anaesthesia (numbness) (1 mark)

Paraesthesia (tingling) (1 mark)

Dysaesthesia (unpleasant sensation/pain) (1 mark)

Question 18

Name THREE steps to debride a wound prior to suturing and briefly describe how each is done (3 marks)

Answer 18

Physical

-Bone file or handpiece to remove sharp bony edges

-Trimmer or curette to remove soft tissue debris (1 mark)

Irrigation: Sterile saline into socket and under flap (1 mark)

Suction: Aspirate under flap to remove debris (1 mark)

Question 19

Name FOUR indication to extract a tooth

Answer 19

Unrestorable teeth

Orthodontic indications

Traumatic position

Symptomatic partially erupted teeth

Question 20

A patient attends your surgery complaining of persistent bleeding after an extraction that was completed one day ago. Give FOUR treatments

Answer 20

Even and firm pressure with damp gauze

Sutures

LA with vasoconstrictor

Diathermy

Question 21

You arrange an appointment for treatment and this is carried out uneventfully. They return the next day complaining they have been bleeding all night. Outline options that you could carry out clinically to deal with this post-operative bleeding. (4 marks)

Answer 21

Prolonged pressure with damp gauze

Sutures

LA with adrenaline

Haemostatic agent e.g surgical, equitamp

Question 22

You arrange an appointment for treatment and this is carried out uneventfully. They return the next day complaining they have been bleeding all night.

If following your interventions, you still could not stop the bleeding - what would you do?

Answer 22

Urgently refer to local OS/OMFS unit or A&E

Question 23

What are FOUR types of sutures and provibe an example of each

Answer 23

Non resorbable monofilament: prolene

Non resorbable multifilament: mersilk

Resorbable monofilament: monocryl

Resorbable multifilament: vicryl

Question 24

What are THREE types of flap designs

Answer 24

2 (envelope) sided flap

3 sided flap

semilunar flap

Question 25

Why do you not use an air driven handpiece for surgical bone removal?

Answer 25

Surgical emphysema risk

Question 26

A patient has returned to the surgery following an extraction carried out by a colleague earlier in the day complaining of continual bleeding from the socket.
List 3 causes that may be contributing to this post-operative complication (3 marks)

Answer 26

Any 3 of:
Damage to periostium / alveolus / vessel during extraction or other local factor
Medication (must state example of antiplatelet, anticoagulant)
Alcoholism
Liver Disease
Systemic Disease such as Haemophilia