ORE Part 1 Oral Surgery 2 — Questions and Answers
Question 1: Which suture material is most commonly used for intraoral wound closure following surgical extraction?
- Nylon (non-resorbable)
- Silk (non-resorbable)
- Polyglycolic acid (resorbable) (Correct answer)
- Stainless steel wire
Correct answer: Polyglycolic acid (resorbable)
Resorbable sutures such as polyglycolic acid (Vicryl) are most commonly used for intraoral closure as they do not require a separate removal appointment and are broken down by hydrolysis. Silk, while still used, harbours bacteria and is non-resorbable, requiring removal at review.
Question 2: A patient on warfarin with an INR of 3.2 presents for extraction of a single-rooted tooth. According to SDCEP guidance, what is the recommended approach?
- Stop warfarin 3 days before extraction
- Proceed with extraction using local haemostatic measures (Correct answer)
- Convert to heparin bridging therapy
- Postpone until INR is below 2.0
Correct answer: Proceed with extraction using local haemostatic measures
SDCEP guidance recommends that patients with a stable INR of 4.0 or below can have up to 3 simple extractions in general practice with local haemostatic measures (oxidised cellulose, sutures, tranexamic acid mouthwash). Warfarin should NOT be stopped as the thromboembolic risk outweighs the bleeding risk.
Question 3: What is the most common benign salivary gland tumour?
- Warthin's tumour
- Pleomorphic adenoma (Correct answer)
- Mucoepidermoid carcinoma
- Adenoid cystic carcinoma
Correct answer: Pleomorphic adenoma
Pleomorphic adenoma accounts for approximately 60–70% of all salivary gland tumours and is the most common benign tumour. It most frequently occurs in the parotid gland and presents as a slow-growing, painless, firm swelling. Treatment is surgical excision with adequate margin.
Question 4: Which fascial space infection carries the highest risk of airway compromise?
- Buccal space
- Canine space
- Ludwig's angina (bilateral submandibular space) (Correct answer)
- Infraorbital space
Correct answer: Ludwig's angina (bilateral submandibular space)
Ludwig's angina involves bilateral infection of the submandibular, sublingual, and submental spaces, causing rapid swelling of the floor of the mouth and tongue elevation. This can lead to fatal airway obstruction and is a surgical emergency requiring immediate hospital admission, IV antibiotics, and potentially surgical decompression or tracheostomy.
Question 5: A 12-year-old child falls and avulses a permanent upper central incisor. The tooth has been dry for 45 minutes. What is the recommended reimplantation protocol?
- Reimplant immediately without any preparation
- Soak in Hank's balanced salt solution for 30 minutes then reimplant
- Do not reimplant as the prognosis is poor
- Soak in sodium fluoride solution, remove necrotic PDL, then reimplant and accept need for later root canal treatment (Correct answer)
Correct answer: Soak in sodium fluoride solution, remove necrotic PDL, then reimplant and accept need for later root canal treatment
When extra-alveolar dry time exceeds 60 minutes (or the PDL is clearly non-viable), the International Association of Dental Traumatology guidelines recommend removing the necrotic PDL, treating the root surface with fluoride, and reimplanting. Root canal treatment will be needed as revascularisation will not occur, but reimplantation preserves alveolar bone for later definitive treatment.
Question 6: Which nerve provides sensory innervation to the buccal gingivae of the mandibular molars?
- Inferior alveolar nerve
- Long buccal nerve (Correct answer)
- Mental nerve
- Mylohyoid nerve
Correct answer: Long buccal nerve
The long buccal nerve (buccal branch of the mandibular division of the trigeminal nerve) provides sensory innervation to the buccal gingivae of the mandibular molars. This is why a separate long buccal nerve block is required in addition to an inferior alveolar nerve block when extracting lower molars.
ORE Part 1 Oral Surgery 2
Which suture material is most commonly used for intraoral wound closure following surgical extraction?