Oral Surgery Past papers Flashcards
Q1 - a fit and healthy 32 year old patient requires surgical removal of his lower left wisdom tooth. He is very anxious about the surgery and has opted to have the treatment carried out under intravenous sedation.
why is written consent required in advance of the treatment day in sedation?
Q1 - a fit and healthy 32 year old patient requires surgical removal of his lower left wisdom tooth. He is very anxious about the surgery and has opted to have the treatment carried out under intravenous sedation.
What drug would a UK trained dentist select to sedate the patient via an intravenous route? and what preparation of this drug should be used?
Q1 - a fit and healthy 32 year old patient requires surgical removal of his lower left wisdom tooth. He is very anxious about the surgery and has opted to have the treatment carried out under intravenous sedation.
What vital signs should you monitor and record before, during and after sedation? (3 marks)
Q1 - a fit and healthy 32 year old patient requires surgical removal of his lower left wisdom tooth. He is very anxious about the surgery and has opted to have the treatment carried out under intravenous sedation.
In the event of over sedation, which drug should you use to reverse the patient?
Q1 - a fit and healthy 32 year old patient requires surgical removal of his lower left wisdom tooth. He is very anxious about the surgery and has opted to have the treatment carried out under intravenous sedation.
List three instructions that the patient should follow post sedation for a minimum of 12 hours after he is discharged from your care
Q2 Your patient has sustained a displaced fracture of the right body of the mandible
Other than pain, bruising and swelling name six other clinical signs or symptoms commonly described in such an injury (3 marks)
- numbness of lower lip
- occlusal derangement (pt cannot bite together properly)
- loose or mobile teeth/groups of teeth
- anterior open bite (shortened ramus due to bilateral subcondylar fracture causes posterior teeth to meet prematurely)
- facial asymmetry
- deviation of mandible to opposite side
Q2 Your patient has sustained a displaced fracture of the right body of the mandible
What are the two most appropriate standard radiographic views that may help in establishing the diagnosis of a mandibular fracture
Two radiographs at right angles to each other
- OPT and PA mandible (posterior anterior)
Q2 Your patient has sustained a displaced fracture of the right body of the mandible
List three factors that may cause displacement of the fracture
- direction of fracture line - if unfavourable direction then it is likely to be displaced
- opposing occlusion
- magnitude of force
- mechanism of injury
- whether soft tissues are intact or not (compound fracture more likely to be displaced than simple fracture)
- number of other associated fractures
Q2 Your patient has sustained a displaced fracture of the right body of the mandible
list three different treatment options for a fractured mandible
- control the pain and infection, providing antibiotics if necessary
- if undisplaced no treatment required and monitor and review
- if displaced
Q3 - A 35 year old male presents with pain, swelling, pus and discharge from around a partially erupted lower right wisdom tooth. He feels slightly unwell and has some mild facial swelling
Describe six features you would specifically consider relating to the patients history, extraoral examination or investigations (3 marks)
- History of presenting complaint: frequency and severity of episodes, pain history, have they required antibiotics in the past for this
- Extraoral examination: is there limited mouth opening
Q3 - A 35 year old male presents with pain, swelling, pus and discharge from around a partially erupted lower right wisdom tooth. He feels slightly unwell and has some mild facial swelling
What is the appropriate immediate management of this patient? (5 marks)
- incision of localised periocoronal abscess +/o local anesthesia (IDB) depending on patient pain
- irrigation with warm saline (10-20ml syringe with blunt needle under the operculum)
- consider XLA of upper third molar if traumatising the operculum
- Advise pt to rinse frequently with warm saline or chlorhexidine mouthwashes
- advise pt to use analgesia (paracetamol or ibuprofen)
- instruct pt to keep fluid levels up and keep eating, sticking to a soft or liquid diet if necessary
- Antibiotics indicated if pt is systemically unwell , prescribe metronidazole (200mg,1 tablet 3 times per day for 3 days)
Q3 - A 35 year old male presents with pain, swelling, pus and discharge from around a partially erupted lower right wisdom tooth. He feels slightly unwell and has some mild facial swelling
What are the two main nerve branches at risk of damage during the removal of the lower wisdom teeth and which structures would be affected in the event of such damage? (2 marks)
- inferior alveolar nerve > supplies mandibular teeth and mucosa/skin of lower lip and chin on that side
- lingual nerve > supplies sensory innervation to anterior 2/3rd of the dorsal and ventral mucosa of tongue as well as lingual gingiva and floor of mouth
If these nerves were damaged sensation to the anterior 2/3rd tongue, lip and lower chin may be altered and taste of anterior 2/3rd tongue altered too
Q4 - you have just completed surgical removal of tooth 37 which fractured during an attempted forceps extraction. Your pt is a 21 year old male with poorly controlled asthma. You intend to prescribe analgesia for the patient
Name a suitable analgesic for this patient that you are allowed to prescribe on an NHS prescription
- paracetamol
Q4 - you have just completed surgical removal of tooth 37 which fractured during an attempted forceps extraction. Your pt is a 21 year old male with poorly controlled asthma. You intend to prescribe analgesia for the patient
which group of analgesic drugs would you avoid in this patient?
- NSAIDs
Q4 - you have just completed surgical removal of tooth 37 which fractured during an attempted forceps extraction. Your pt is a 21 year old male with poorly controlled asthma. You intend to prescribe analgesia for the patient
List all of the essential information that you should include when you are writing an NHS prescription (16 marks)
-All prescriptions written legibly in ink
- Patients full name, address and CHI
- Age and DOB of patient (legal requirement if under 12)
- Name and address of prescriber
- Status of prescriber
- signature of prescriber in ink
- Write names of drugs and preparations clearly using approved titles and no abbreviations
- form (tablet/capsule/liquid) and strength of drug
- dose and dose frequency
- state quantity or volume to be supplied (send)
- duration of treatment
- instructions for how and when (label)
Q4 - you have just completed surgical removal of tooth 37 which fractured during an attempted forceps extraction. Your pt is a 21 year old male with poorly controlled asthma. You intend to prescribe analgesia for the patient
Where would you refer to for the dose and possible interactions of a drug you are prescribing?
BNF - British National Formulary
Q4 - you have just completed surgical removal of tooth 37 which fractured during an attempted forceps extraction. Your pt is a 21 year old male with poorly controlled asthma. You intend to prescribe analgesia for the patient
How long is an NHS prescription for a non-controlled drug valid for?
6 months
Q5 - a 48 year old female presents complaining of fluid escaping from her nose when she drinks. She had tooth 27 extracted 6 months ago - this was a difficult extraction and she says she has been aware of a hole in her gum ever since. You examine her and find a communication between the oral cavity and maxillary sinus
What is the correct clinical term for this problem (1 mark)
Oral-antral fistula
Q5 - a 48 year old female presents complaining of fluid escaping from her nose when she drinks. She had tooth 27 extracted 6 months ago - this was a difficult extraction and she says she has been aware of a hole in her gum ever since. You examine her and find a communication between the oral cavity and maxillary sinus
Other than fluid escape from the nose when drinking, list 5 patient symptoms that may be elicited on taking the history (5 marks)
- problems with speech or singing
- problems smoking or using a straw
- bad taste/halitosis
- pain and sinusitis type symptoms
- problems playing brass or wind instruments
Q5 - a 48 year old female presents complaining of fluid escaping from her nose when she drinks. She had tooth 27 extracted 6 months ago - this was a difficult extraction and she says she has been aware of a hole in her gum ever since. You examine her and find a communication between the oral cavity and maxillary sinus
Briefly describe the operative procedure to treat this condition, assuming appropriate anaesthesia has been achieved (4 marks)
- Excise the epithelial sinus tract
- Raise a flap, commonly a buccal advancement flap
- excise the periosteum
- Antral washout if there is chronic sinusitis
- Close OAF using non-resorbing sutures
- keep these sutures in for 2 weeks, reviewing the patient after 1 week to assess closure
Q6 You have extracted tooth 26 but the bleeding won’t stop.
List how you would manage the situation and gain haemostasis
- Apply pressure: get patient to bite on damp gauze or if edentulous use mechanical pressure with finger over gauze (gauze must be damp as dry gauze will pull out the clot)
- sutures: can suture socket to encourage haemostasis
- Haemostatic agents: surgical oxidised cellulose forms a scaffold for blood to clot to, LA with vasoconstrictor
- Ligation of vessels with diathermy
- Bone wax: bone wax on flat plastic gives waterproof layer over bone
Q6 You have extracted tooth 26 but the bleeding won’t stop.
What is a local risk factor for delayed onset of bleeding? - revise this questions answer
- mucoperiosteal tears
- fractures of alveolar plate or socket wall
Q6 You have extracted tooth 26 but the bleeding won’t stop.
List 2 conditions for each of the following - congenital and acquired bleeding disorders
congenital bleeding disorders: von willebrands’ disease, haemophilia A
Acquired bleeding disorders: end stage liver disease, vitamin K deficiency
Q6 You have extracted tooth 26 but the bleeding won’t stop.
The patient is on a new oral anticoagulant, should you check the INR no more than 48 hours prior to extraction true or false?
False - INR is not required for NOAC’s
High risk bleeding procedures
- miss apixaban/dabigatran the morning of surgery
- delay rivaroxaban dose until later in day
Q6 You have extracted tooth 26 but the bleeding won’t stop.
What should the INR be for a patient on warfarin for oral surgery to be carried out
<4
Q7 A patient attends with suspected dry socket
What is the scientific term for a dry socket
localised alveolar osteitis - condition occurring after tooth extraction which results in a dry appearance of the exposed bone in the socket due to the disintegration or loss of the blood clot
Q7 A patient attends with suspected dry socket
What are the predisposing risk factors for a dry socket?
- molar teeth (risk increases from anterior to posterior)
- mandibular teeth
- smoking
- female
- oral contraceptive pill
- local anaesthetic with a vasoconstrictor
Q7 A patient attends with suspected dry socket
What are the treatment options
- Reassure patient - check that it is a dry socket and that no tooth fragments or bony sequestra remain
- LA block - provide pain relief to allow you to carry out irrigation
- Irrigate socket with warm saline to wash out food and debris
- Debridement with a small curette to remove any old clot, encourage bleeding and new clot formation
- Pack socket with alvogyl (mixture of LA and antiseptic - will disintegrate on own) to sooth pain and prevent food packing
- advise patient on analgesia and warm salty mouthwashes
- review patient
Q8 A patient attends with pericoronitis of the lower 8
What is pericoronitis
Inflammation around the crown of a partially erupted tooth - food and debris get trapped under the operculum resulting in inflammation and infection
Q8 A patient attends with pericoronitis of the lower 8
What are the signs and symptoms of pericoronitis
- Pain
- swelling intraoral or extraoral
- bad taste
- pus discharge
- occlusal trauma to the operculum
- ulceration of operculum
- evidence of cheek biting
- foetor oris bad breath
- limited mouth opening
- dysphagia difficulty swallowing food or liquid
- pyrexia raised body temperature
- malaise
- regional lymphadenopathy
Q8 A patient attends with pericoronitis of the lower 8
How is pericoronitis treated
- incise localised periocoronal abscess if required +/- IDB depending on patient/ pain
- irrigate with warm saline or chlorhexidine mouthwash (10-20ml in blunt needle under operculum)
- XLA of upper third molars if traumatising the operculum
- instruct pt to rinse with warm saline or chlorhexidine
- give advise on analgesia
- do not prescribe antibiotics unless severe
Q8 A patient attends with pericoronitis of the lower 8
What 6 radiographic signs show a close relationship of the lower 8 with IAN?
- diversion of the inferior alveolar nerve canal
- darkening of the root where crossed by the canal
- interruption of the white lines (tram lines) of the canal
- deflection of the root
- narrowing of the inferior alveolar canal
- dark and bifid roots
- juxta apical area
Q8 A patient attends with pericoronitis of the lower 8
What imaging is requested when an 8 is close to IAN?
- OPT
Q8 A patient attends with pericoronitis of the lower 8
What risks should be explained to the patient with regards to damage to IAN of extracting the tooth?
- change in sensation to the lower lip, chin and side of tongue. May also be a change in sensation of taste. This could be temporary or permanent; 10-20% temporary and <1% permanent
Q8 A patient attends with pericoronitis of the lower 8
What treatment option for this patient would reduce the risk of complications stated above?
coronectomy
Q8 A patient attends with pericoronitis of the lower 8
Name 2 scenarios where there would be an increased risk of bleeding for a patient and 2 post operative methods of achieving haemostasis
- patient on an anticoagulant or patient has bleeding disorder.
Q9 A patient attends you practice complaining of jaw stiffness and on examination you notice intra-oral signs of bruxism and diagnose TMD.
What are 6 signs and symptoms of TMD
- intermittent pain of several months or years duration
- pain on opening
- limited mouth opening
- muscle/joint/ear pain particularly on wakening
- trismus and locking commonly associated
- clicking and popping noises
- headaches around temporalis region
- signs of wear intraorally - linea alba, wear facets, tongue scalloping
- facial aymmetry
Q9 A patient attends you practice complaining of jaw stiffness and on examination you notice intra-oral signs of bruxism and diagnose TMD.
What 2 muscles should be palpated when querying TMD
- temporalis muscle and masseter muscle
Q9 A patient attends your practice complaining of jaw stiffness and on examination you notice intra-oral signs of bruxism and diagnose TMD
You decide to give the patient conservative advice. List 5 points of conservative advice you would give
- reassurance about condition
- soft diet
- masticate bilaterally
- stop parafunctional habits
- support mouth opening on yawning
- dont chew gum
- jaw exercises - massages, relaxation techniques
- splints (bite raising appliance like michigan)
- medications - NSAIDs, muscle relaxants, tricyclic antidepressants
Q9 A patient attends your practice complaining of jaw stiffness and on examination you notice intra-oral signs of bruxism and diagnose TMD
What nerve supplies the TMJ
auriculotemporal and masseteric branches of the mandibular branch of trigmenial nerve
Q9 A patient attends your practice complaining of jaw stiffness and on examination you notice intra-oral signs of bruxism and diagnose TMD
What are the mechanisms of a bite splint
- aim to stabilize jaw and ease muscle tension
Q9 A patient attends your practice complaining of jaw stiffness and on examination you notice intra-oral signs of bruxism and diagnose TMD
What is arthrocentesis
Q9 A patient attends your practice complaining of jaw stiffness and on examination you notice intra-oral signs of bruxism and diagnose TMD
Give two possible surgical options
