Oral and Maxillofacial Surgery
Core concepts
Surgical questions test safe decision-making: assessment, consent, anaesthesia choice, technique, and recognition of complications. For exodontia, know indications, contraindications, and the principles of a sound extraction - adequate access, anaesthesia, controlled force, and atraumatic technique. Understand when a surgical extraction is indicated: gross caries, ankylosis, hypercementosis, divergent roots, or previous failed attempt.
Learn third molar assessment: angulation, root morphology, relationship to the inferior alveolar nerve and adjacent second molar, and signs of pericoronitis. Coronectomy may be preferred when the nerve is intimately related to the roots. Know the classic complications and their management: dry socket (alveolar osteitis) presents with severe pain and empty socket days after extraction, managed by irrigation and dressing, not antibiotics alone; bleeding is managed by pressure, local measures, and review of anticoagulants; nerve injury requires documentation and referral.
Medical emergencies and special care
Know how to manage syncope (supine, legs raised), hypoglycaemia (oral glucose if conscious), and anaphylaxis (adrenaline intramuscularly). Anticoagulated patients need INR review and local haemostatic measures rather than automatic withdrawal of therapy.
Traps
- Prescribing antibiotics for dry socket instead of local treatment.
- Failing to consider nerve proximity before lower third molar removal.
- Assuming all anticoagulated patients must stop medication.
Worked example
Three days after a lower molar extraction, a patient has severe throbbing pain, an empty socket, and no swelling. Rule of thumb: dry socket is a clinical diagnosis treated by irrigation and a medicated dressing; antibiotics are not first-line unless there is spreading infection.