ORE Part 2 Oral Surgery & Extractions 4 — Questions and Answers
Question 1: What is the recommended storage medium for an avulsed permanent tooth before reimplantation?
- Milk or Hank's Balanced Salt Solution (HBSS) (Correct answer)
- Water
- Dry gauze
- Saline only
Correct answer: Milk or Hank's Balanced Salt Solution (HBSS)
Milk is the most practical recommended storage medium (HBSS is ideal but impractical) as it maintains PDL cell viability; dry storage causes rapid PDL cell death.
Question 2: At what age is surgical removal of unerupted lower third molars with no pathology generally not recommended?
- Over 35 years (increased surgical morbidity) (Correct answer)
- Over 25 years
- Under 18 years
- Any age if unerupted
Correct answer: Over 35 years (increased surgical morbidity)
NICE guidelines previously recommended against prophylactic removal of disease-free third molars; risk of complications (nerve injury, slow healing) increases with age after 35.
Question 3: What is the most important pre-operative assessment before extracting an upper molar in a patient on anticoagulants?
- Check INR and liaise with anticoagulation clinic; proceed if INR ≤ 3.5 (Correct answer)
- Stop anticoagulants 5 days before
- Always refer to hospital
- Proceed regardless of INR
Correct answer: Check INR and liaise with anticoagulation clinic; proceed if INR ≤ 3.5
Current UK guidelines recommend checking INR before dental extractions; if ≤3.5, proceed with local haemostatic measures (pack, sutures, tranexamic acid mouthwash) without stopping warfarin.
Question 4: What does the term 'coronectomy' refer to in third molar surgery?
- Deliberate removal of the crown only, leaving roots in situ when close to the IAN (Correct answer)
- Full tooth removal in sections
- Surgical removal of the root only
- Apicectomy of the third molar
Correct answer: Deliberate removal of the crown only, leaving roots in situ when close to the IAN
Coronectomy involves removing only the crown of a deeply impacted lower third molar when roots are in intimate contact with the IAN, to avoid nerve injury.
Question 5: Which anatomical structure defines the posterior boundary of the pterygomandibular space?
- Medial pterygoid muscle (Correct answer)
- Lateral pterygoid muscle
- Masseter muscle
- Buccinator muscle
Correct answer: Medial pterygoid muscle
The medial pterygoid muscle forms the medial and posterior boundary of the pterygomandibular space, which is entered during inferior alveolar nerve block administration.
Question 6: What is the significance of a 'sentinel loop' sign on a chest X-ray following wisdom tooth removal?
- It is not relevant to wisdom tooth surgery — it indicates pancreatitis (Correct answer)
- It confirms normal chest anatomy
- It indicates mandibular fracture
- It shows subcutaneous emphysema
Correct answer: It is not relevant to wisdom tooth surgery — it indicates pancreatitis
A sentinel loop is a radiological sign of localised ileus associated with pancreatitis — it has no direct relevance to wisdom tooth surgery and illustrates the importance of differential diagnosis.
ORE Part 2 Oral Surgery & Extractions 4
What is the recommended storage medium for an avulsed permanent tooth before reimplantation?