MFDS Part 1 - Membership of Faculty of Dental Surgery Oral Surgery and Exodontia Questions and Answers

Question 1

A 68-year-old patient taking apixaban for atrial fibrillation requires a routine extraction of a single molar tooth. According to the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance, what is the most appropriate management plan?

Accepted Answer

Proceed with the extraction without altering the medication regimen, using local haemostatic measures.

Answer

SDCEP guidance on managing patients on anticoagulant drugs states that for procedures with a low risk of bleeding, such as a simple extraction, patients taking Direct Oral Anticoagulants (DOACs) like apixaban should not have their medication interrupted. The risk of a thromboembolic event from stopping the medication outweighs the risk of post-operative bleeding, which can be effectively managed with local measures like suturing and packing the socket.

Question 2

According to the National Institute for Health and Care Excellence (NICE) Technology Appraisal Guidance [TA1], which of the following is an accepted indication for the surgical removal of an impacted third molar?

Accepted Answer

The presence of non-treatable pulpal pathology in the third molar.

Answer

NICE guidance TA1 explicitly states that the prophylactic removal of pathology-free impacted third molars should be discontinued. It lists specific pathological conditions as indications for removal, which include non-treatable pulpal and/or periapical pathology, unrestorable caries, cellulitis, abscesses, and cysts. A single mild episode of pericoronitis is not a firm indication, though recurrent or severe episodes are. Preventing future crowding is not an evidence-based indication for removal.

Question 3

During the extraction of a maxillary first molar, a 3mm oro-antral communication (OAC) is created. The sinus lining appears intact and the patient is healthy with no history of sinusitis. What is the most appropriate immediate management?

Accepted Answer

Provide post-operative instructions to avoid nose-blowing and allow healing by secondary intention.

Answer

For a small oro-antral communication (generally considered <5mm) with an intact sinus membrane in a healthy patient, the blood clot is often sufficient to seal the defect and allow for spontaneous healing. The most critical immediate step is to provide clear post-operative instructions to protect the clot, such as avoiding nose-blowing, sneezing with the mouth open, and using straws. Surgical closure with a flap is typically reserved for larger defects (>5mm) or if conservative management fails.

Question 4

A 72-year-old patient has been taking oral alendronic acid for osteoporosis for seven years. They require extraction of a mandibular molar. According to SDCEP guidance on Medication-related Osteonecrosis of the Jaw (MRONJ), which factor places this patient in the 'higher risk' category?

Accepted Answer

The duration of bisphosphonate use is greater than 5 years.

Answer

The SDCEP guidance categorises patients based on their risk of developing MRONJ. For patients taking oral bisphosphonates for osteoporosis, the duration of therapy is a key risk factor. Use for over 5 years elevates the patient to the 'higher risk' category. Other factors for higher risk include concurrent systemic steroid use or a history of cancer. While mandibular extractions and age are general risk factors, the duration of therapy is the specific criterion listed that defines the higher risk category in the guidance.

Question 5

When raising a full-thickness mucoperiosteal flap for the surgical removal of an impacted mandibular third molar, which technical principle is most crucial for preventing iatrogenic injury to the lingual nerve?

Accepted Answer

Keeping the periosteal elevator in constant, firm contact with the lingual plate of bone during elevation.

Answer

The lingual nerve has a variable course but often lies in very close proximity to the lingual cortical plate, sometimes within the periosteum. The safest technique is to keep the elevator firmly on the bone surface, elevating the entire mucoperiosteum (including the nerve) as a single, intact unit. This protects the nerve from being torn or crushed. Placing retractors blindly or making incisions directly into the lingual soft tissues significantly increases the risk of direct nerve trauma.

MFDS Part 1 Practice Test

MFDS Part 1 Practice Test

MFDS Part 1 - Membership of Faculty of Dental Surgery Oral Surgery and Exodontia Questions and Answers