Oral and Maxillofacial Surgery
What the exam tests
Oral and maxillofacial surgery questions test safe decision-making more than operative trivia: when to extract, when to refer, how to recognize spreading infection, and how to manage bleeding, trauma and nerve risk in medically complex patients. Expect third-molar assessment, odontogenic infection, biopsy principles, MRONJ and emergency recognition.
Core rules and concepts
- Third molars: base removal on pathology or credible risk (recurrent pericoronitis, caries, cyst, resorption of the adjacent tooth, orthodontic need), not on impaction alone. Describe angulation (Winter) and depth/ramus relation (Pell–Gregory). Assess inferior alveolar nerve proximity on panoramic imaging and use CBCT when the canal overlaps the roots or the surgical plan depends on it.
- Odontogenic infection: cellulitis with trismus, dysphagia, floor-of-mouth elevation or systemic toxicity needs urgent referral, airway assessment, incision and drainage plus antibiotics. Ludwig angina is bilateral submandibular–sublingual–mental space infection and is an airway emergency.
- Bleeding: local pressure, sutures and tranexamic acid mouthwash; do not routinely stop warfarin or DOACs - check INR and coordinate. Hemophilia needs factor replacement, not local measures alone.
- Avulsion: handle by the crown, replant immediately if possible, store in milk, saline or HBSS, and splint flexibly for about two weeks. Mature teeth need root canal treatment within roughly two weeks; immature teeth aim for revascularization.
- MRONJ: risk rises with IV bisphosphonates and denosumab; prioritize prevention and conservative care. A drug holiday is a specialist decision, not routine.
Worked example
A 28-year-old has a horizontally impacted 38 with a radiolucency, and the canal crosses the roots. Reasoning: the cyst-like change is pathology, so removal is indicated; because the canal overlaps, obtain CBCT and consent specifically for temporary or permanent sensory disturbance; consider coronectomy if the root is intimately related to the canal and the tooth is asymptomatic.
Traps
Extracting because a tooth "might cause problems"; prescribing antibiotics without drainage; stopping anticoagulation without advice; treating trismus as a standalone indication; missing airway signs.