ORE Part 1 Oral Surgery — Questions and Answers
Question 1: During surgical extraction of a lower third molar, the lingual nerve is most at risk at which anatomical location?
- At the level of the sigmoid notch
- At the lingual plate of the third molar region, just below the alveolar crest (Correct answer)
- At the mental foramen
- At the lingula of the mandible
Correct 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.
Question 2: A patient develops numbness of the lower lip immediately following extraction of a lower premolar. Which nerve has most likely been damaged?
- Inferior alveolar nerve
- Mental nerve (Correct answer)
- Lingual nerve
- Buccal nerve
Correct 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.
Question 3: What is the most common complication following extraction of maxillary molars?
- Inferior alveolar nerve damage
- Oroantral communication (Correct answer)
- Mandibular fracture
- Ludwig's angina
Correct 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.
Question 4: 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?
- Normal post-extraction healing
- Alveolar osteitis (dry socket) (Correct answer)
- Osteomyelitis
- Residual root fracture
Correct 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.
Question 5: Which of the following is an absolute contraindication to dental extraction without specialist referral?
- Well-controlled type 2 diabetes
- Patients on low-dose aspirin
- Patients receiving intravenous bisphosphonate therapy for bone metastases (Correct answer)
- History of mild penicillin allergy
Correct 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.
Question 6: During elevation of a lower third molar root, the root tip is displaced lingually. What is the immediate best course of action?
- Attempt retrieval with a Mitchell's trimmer through the socket
- Raise a lingual flap and retrieve under direct vision
- Leave it and inform the patient
- Take a radiograph, note the location, and refer to a specialist oral surgeon (Correct answer)
Correct 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.
ORE Part 1 Oral Surgery
During surgical extraction of a lower third molar, the lingual nerve is most at risk at which anatomical location?