ADC - Australian Dental Council Minor Oral Surgery Questions and Answers

Question 1

A 65-year-old patient on long-term warfarin therapy for atrial fibrillation requires a simple extraction of tooth 36. His recent INR reading is 2.8. According to Australian Therapeutic Guidelines, what is the most appropriate management plan?

Accepted Answer

Proceed with the extraction using effective local haemostatic measures.

Answer

Australian and international guidelines recommend that for simple extractions (1-3 teeth), patients with a therapeutic INR up to 4.0 can proceed without altering their warfarin regimen. The risk of a thromboembolic event from stopping warfarin far outweighs the risk of post-operative bleeding, which can be managed effectively with local measures such as packing the socket with a haemostatic agent and suturing.

Question 2

A patient presents 3 days after the extraction of tooth 46 with severe, radiating pain and a foul taste. Clinical examination reveals an empty socket with exposed, sensitive bone. What is the primary goal in the management of this alveolar osteitis (dry socket)?

Accepted Answer

To provide symptomatic relief of pain while healing by secondary intention occurs.

Answer

Alveolar osteitis (dry socket) is a localised inflammatory condition, not a true infection, caused by the premature loss of the blood clot. The primary goal of management is palliative care to relieve the patient's severe pain. This is achieved by gentle irrigation to clean the socket of debris and placing a sedative dressing (e.g., Alvogyl or zinc oxide-eugenol pack). Systemic antibiotics are not indicated unless there are signs of spreading infection.

Question 3

During the extraction of a maxillary first molar (tooth 16), you suspect a small oroantral communication (OAC) of approximately 2mm has been created. There is no pre-existing sinus pathology. What is the most appropriate immediate management?

Accepted Answer

Promote and protect the blood clot with a haemostatic agent and a figure-of-eight suture.

Answer

For a small OAC (<2-3 mm) in a healthy sinus, the primary objective is to maintain a stable blood clot within the socket, which will allow for spontaneous healing. This is best achieved by placing a resorbable haemostatic agent (e.g., Gelfoam) and securing it with a suture (e.g., figure-of-eight) to provide a scaffold for the clot. While sinus precautions and medications are important adjuncts, the key immediate step is mechanical protection of the clot. Larger defects (>5mm) typically require surgical flap closure.

Question 4

A 22-year-old patient presents with severe pain, trismus, and swelling associated with a partially erupted tooth 38. There is purulent discharge from under the operculum. Which of the following is the most appropriate initial management for this acute pericoronitis?

Accepted Answer

Gentle irrigation under the operculum and debridement, with antibiotics reserved for systemic signs.

Answer

The initial management of acute pericoronitis focuses on resolving the acute inflammatory and infectious process before definitive treatment. This involves local measures, primarily gentle irrigation of the sub-opercular space with saline or an antiseptic solution to remove debris and reduce the bacterial load. Systemic antibiotics are only indicated if there are signs of systemic involvement (e.g., fever, lymphadenopathy, severe trismus) or spreading infection. Extraction is deferred until the acute phase is controlled.

Question 5

A dentist identifies a 1.5 cm, indurated, non-healing ulcer on the lateral border of the tongue of a 60-year-old male smoker. The lesion is suspicious for malignancy. Which of the following is the most appropriate diagnostic step?

Accepted Answer

Perform an incisional biopsy taking a wedge of tissue from the lesion's border.

Answer

For a lesion that is clinically suspicious of malignancy or larger than 1cm, an incisional biopsy is the standard of care. This procedure provides a representative tissue sample to establish a definitive histopathological diagnosis before a definitive treatment plan (often involving wide excision and specialist care) is formulated. Excisional biopsy is typically reserved for smaller (<1cm) lesions that appear benign. Delaying diagnosis of a suspicious lesion is inappropriate.

ADC - Australian Dental Council Practice Test

ADC - Australian Dental Council Practice Test

ADC - Australian Dental Council Minor Oral Surgery Questions and Answers