Dental Surgery: Safe Exodontia and Minor Oral Surgery
Dental Surgery in the MDCN assessment tests applied exodontia and minor oral surgery: preoperative assessment, local anaesthesia, surgical technique, and recognition and management of complications. Questions reward safe decision-making and structured aftercare more than obscure instrument names.
Pre-extraction assessment
Take a focused history for bleeding disorders and anticoagulants (warfarin, DOACs), antiresorptives (bisphosphonates, denosumab), immunosuppression, previous head and neck radiotherapy, cardiac valve disease, and allergy. Record mouth opening, access, tooth mobility, caries, opposing dentition, and signs of spreading infection. Image when root morphology is uncertain, roots approach the inferior alveolar canal or maxillary sinus, or infection suggests retained roots.
Principles of a forceps extraction
Profound anaesthesia is the first rule; use buccal and palatal/lingual infiltration or an appropriate block. Then follow a consistent sequence: periotome or syndesmotomy to sever the gingival attachment, elevation to create space, forceps applied apical to the CEJ, slow buccal and lingual expansion, and controlled delivery. Support the mandible with the non-dominant hand, and avoid levering against a lone maxillary molar.
Worked example
A 45-year-old with a metallic heart valve on warfarin, INR 3.4, needs extraction of a mobile 36. The reasoning is not to memorise a single INR threshold but to recognise the risk: do not extract at an INR above the local protocol, liaise with the physician or cardiology team, recheck INR within 24–72 hours, and use local haemostatic measures. If the patient cannot be optimised, refer.
Traps that cost marks
- Labelling dry socket as infection: it is fibrinolysis, managed by irrigation and a dressing, not routinely antibiotics.
- Failing to document paraesthesia after an inferior alveolar block or to review it.
- Discharging a patient with trismus, dysphagia, or floor-of-mouth swelling.