MJDF Part 1 - Membership of Joint Dental Faculties Oral Surgery and Exodontia Questions and Answers

Question 1

A 68-year-old patient taking apixaban 5mg twice daily for atrial fibrillation requires a routine extraction of a single mobile maxillary premolar.
The procedure is expected to be straightforward.
According to the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance, what is the most appropriate management of their anticoagulant therapy?

Accepted Answer

Proceed with the extraction without altering the apixaban regimen, using local haemostatic measures.

Answer

Advise the patient to stop taking apixaban for 3 days prior to the extraction.

Answer

Liaise with the patient's GMP to arrange bridging therapy with low molecular weight heparin.

Answer

Check the patient's INR on the day of the procedure and proceed if it is below 4.0.

Question 2

A 24-year-old patient presents with severe, localised pain and a foul taste two days after the surgical extraction of their lower right third molar (LR8). On examination, the socket appears empty with exposed bone, and a blood clot is absent. Which of the following is considered the most significant patient-related risk factor for developing this condition?

Accepted Answer

Use of an oral contraceptive pill

Answer

Male gender

Answer

Age over 50 years

Answer

History of pre-operative anxiety

Question 3

During the surgical extraction of a multi-rooted lower first molar, the mesial root is removed, but the distal root fractures and remains in the socket. Which instrument is specifically designed to be applied into the empty socket, using the inter-radicular bone as a fulcrum, to elevate the remaining fractured root?

Accepted Answer

Cryer's elevator

Answer

Coupland's elevator

Answer

Warwick James elevator

Answer

Hospital pattern forceps

Question 4

During the extraction of an upper left second premolar (UL5), a 2mm apical root fragment fractures and remains in the socket. A periapical radiograph confirms the fragment is small, not in close proximity to the maxillary sinus, and there is no evidence of pre-existing infection. What is the most appropriate definitive management?

Accepted Answer

Inform the patient, document the event, and leave the fragment in situ for monitoring.

Answer

Immediately refer the patient to an oral surgeon for removal under sedation.

Answer

Attempt surgical removal by raising a flap and removing bone for at least 30 minutes.

Answer

Prescribe a 5-day course of amoxicillin and review the patient in one week.

Question 5

A 22-year-old patient presents with acute, localised pain and swelling associated with a partially erupted lower left third molar (LL8). There is pus exuding from beneath the operculum on gentle pressure. The patient is systemically well, with no fever, facial cellulitis, or significant trismus (<2 finger breadths opening). According to the Faculty of General Dental Practice (UK) 'Antimicrobial Prescribing in Dentistry' guidelines, what is the most appropriate initial management?

Accepted Answer

Perform local debridement and irrigation of the pericoronal space.

Answer

Prescribe a 5-day course of metronidazole 400mg.

Answer

Advise hot salt water mouthbaths and arrange for extraction in one week.

Answer

Prescribe a 5-day course of amoxicillin 500mg.

Question 6

Following the extraction of a maxillary first molar, the 'nose-blowing' test is positive, and a visible defect of approximately 4mm is noted in the socket floor. Which of the following represents the most appropriate immediate management for this oroantral communication (OAC)?

Accepted Answer

Attempt primary surgical closure of the defect, typically with a buccal advancement flap.

Answer

Pack the socket with haemostatic gauze and provide standard post-operative instructions.

Answer

Advise nasal decongestants and antibiotics and review the patient in 24 hours.

Answer

Take an occlusal radiograph to determine the exact size of the communication.