Oral Surgery Flashcards

During surgical extraction of a lower third molar, the lingual nerve is most at risk at which anatomical location?

Answer: At the lingual plate of the third molar region, just below the alveolar crest

The lingual nerve runs in close proximity to the lingual plate in the third molar region, often lying at or just below the level of the alveolar crest. Studies have shown it is directly on the bone surface in approximately 15% of cases, making it vulnerable during flap elevation and bone removal.

A patient develops numbness of the lower lip immediately following extraction of a lower premolar. Which nerve has most likely been damaged?

Answer: Mental nerve

The mental nerve exits through the mental foramen, typically located between the apices of the lower premolars. During premolar extraction, the mental nerve can be damaged by direct trauma, excessive periosteal elevation, or compression, resulting in numbness of the lower lip and chin on the affected side.

What is the most common complication following extraction of maxillary molars?

Answer: Oroantral communication

Oroantral communication (OAC) is the most common complication of upper molar extractions due to the close relationship between the molar roots and the maxillary sinus floor. If the OAC is less than 2mm, it may close spontaneously; larger communications require surgical closure with a buccal advancement flap.

A patient presents 3 days post-extraction with severe throbbing pain, a foul taste, and an empty socket with exposed bone. What is the diagnosis?

Answer: Alveolar osteitis (dry socket)

Alveolar osteitis (dry socket) typically presents 2–5 days after extraction with severe pain, halitosis, and an empty socket where the blood clot has been lost or lysed. Risk factors include smoking, oral contraceptive use, and traumatic extraction. Management involves irrigation and placement of an obtundent dressing.

Which of the following is an absolute contraindication to dental extraction without specialist referral?

Answer: Patients receiving intravenous bisphosphonate therapy for bone metastases

Patients on intravenous bisphosphonates (e.g., zoledronic acid for bone metastases) have a significantly elevated risk of MRONJ compared to oral bisphosphonate users. These patients should be referred to a specialist oral surgery unit for extraction with appropriate planning and follow-up.

During elevation of a lower third molar root, the root tip is displaced lingually. What is the immediate best course of action?

Answer: Take a radiograph, note the location, and refer to a specialist oral surgeon

A displaced root fragment in the lingual tissues should not be pursued through the socket or by raising a lingual flap in a general practice setting, as this risks lingual nerve damage and displacement into deeper tissue spaces. The correct approach is to document the event radiographically and refer to a specialist.