ORE Part 2 Oral Surgery & Extractions 2 — Questions and Answers
Question 1: What is the correct management of a patient with suspected Ludwig's angina?
- Immediate hospital admission, IV antibiotics, airway management, and surgical drainage (Correct answer)
- Oral antibiotics and review in 48 hours
- Extraction of causative tooth in practice
- Incision and drainage in the dental chair without admission
Correct answer: Immediate hospital admission, IV antibiotics, airway management, and surgical drainage
Ludwig's angina is a life-threatening spreading cellulitis of the floor of the mouth; immediate hospitalisation, IV antibiotics, and airway protection are mandatory.
Question 2: Which nerve is at risk of damage during extraction of a lower premolar?
- Mental nerve (Correct answer)
- Inferior alveolar nerve
- Lingual nerve
- Long buccal nerve
Correct answer: Mental nerve
The mental nerve emerges from the mental foramen near the apices of the lower premolars and is at risk during surgical procedures or overzealous elevation in this region.
Question 3: What is the maximum recommended dose of lidocaine with adrenaline for a 70 kg adult in the UK?
- 500 mg (7 mg/kg) (Correct answer)
- 200 mg
- 300 mg
- 700 mg
Correct answer: 500 mg (7 mg/kg)
The maximum safe dose of lidocaine with adrenaline is 7 mg/kg, equating to approximately 500 mg (about 14 cartridges of 2% lidocaine with 1:80,000 adrenaline) for a 70 kg adult.
Question 4: In the WHARFE assessment for lower third molar surgery difficulty, what does the 'H' stand for?
- Height of mandibular ramus (Correct answer)
- Horizontal impaction angle
- Hardness of bone
- History of infection
Correct answer: Height of mandibular ramus
In the WHARFE index, 'H' represents the Height of the mandibular ramus, which affects the difficulty of surgical access to the third molar.
Question 5: What is the first-line management for a patient presenting with a displaced tooth following dentoalveolar trauma?
- Reimplant immediately if avulsed, or reposition and splint if luxated (Correct answer)
- Extract and provide a denture
- Take radiographs and review in one week
- Prescribe analgesia only
Correct answer: Reimplant immediately if avulsed, or reposition and splint if luxated
Immediate reimplantation of avulsed teeth (or repositioning of luxated teeth) and splinting with a semi-rigid splint offers the best prognosis for tooth survival.
Question 6: Which condition contraindicates the use of adrenaline-containing local anaesthetic in a dental patient?
- Uncontrolled phaeochromocytoma (Correct answer)
- Well-controlled hypertension
- Type 2 diabetes
- Asthma
Correct answer: Uncontrolled phaeochromocytoma
Phaeochromocytoma is a catecholamine-secreting tumour; exogenous adrenaline can trigger a hypertensive crisis, making it an absolute contraindication.
ORE Part 2 Oral Surgery & Extractions 2
What is the correct management of a patient with suspected Ludwig's angina?