Oral Surgery Flashcards

A patient presents with acute pericoronitis around an impacted mandibular third molar. What is the correct initial management?

Answer: Irrigation under the operculum, debridement, and antibiotics only if systemic signs are present

Acute pericoronitis is first managed with local debridement, irrigation under the operculum, and systemic antibiotics if there is fever or spreading infection; extraction is deferred until acute inflammation resolves.

Which suture material is most appropriate for intraoral closure when the patient cannot return for suture removal?

Answer: 4-0 polyglactin (Vicryl)

Polyglactin (Vicryl) is a resorbable multifilament suture that undergoes hydrolysis within 60–90 days, eliminating the need for a removal appointment.

The lingual nerve is at greatest risk of injury during which surgical procedure?

Answer: Extraction of mandibular third molars with lingual flap reflection

The lingual nerve courses just beneath the lingual periosteum in the third molar region and can be stretched, crushed, or severed when a lingual retractor or periosteal elevator is used during mandibular third molar surgery.

Winter's classification of impacted mandibular third molars describes which characteristic of the tooth?

Answer: Angulation of the impacted tooth relative to the long axis of the second molar

Winter's classification categorizes impacted mandibular third molars by their angulation: mesioangular, distoangular, vertical, horizontal, buccoangular, and linguoangular.

Which common analgesic should be used with caution post-extraction due to its platelet-inhibiting effect that may impair clot stability?

Answer: Ibuprofen (NSAIDs)

NSAIDs such as ibuprofen reversibly inhibit cyclooxygenase enzymes and reduce thromboxane A2-mediated platelet aggregation, which can impair post-extraction clot formation and increase risk of dry socket.

A patient reports numbness of the lower lip and chin persisting 6 months after mandibular third molar extraction. This finding most likely represents:

Answer: Permanent injury (axonotmesis or neurotmesis) to the inferior alveolar nerve

Neuropraxia resolves within days to weeks; persistent lower lip and chin numbness at 6 months indicates a more severe axonotmesis or neurotmesis injury to the inferior alveolar nerve, which may be permanent.

What do current evidence-based guidelines recommend regarding routine antibiotic prophylaxis for third molar extraction in healthy, immunocompetent patients?

Answer: Routine prophylactic antibiotics are not strongly supported and may contribute to antibiotic resistance

Current evidence and guidelines indicate that routine antibiotic prophylaxis does not significantly reduce post-operative infection rates in healthy patients and is discouraged due to the risk of antibiotic resistance and adverse effects.