Oral Surgery & Local Anaesthesia for ORE Part 1
Review of nerve blocks (IANB, PSA, Nasopalatine), surgical extractions, coronectomy, DOACs, and MRONJ guidelines for ORE Part 1.
Key Syllabus Concepts Tested in Oral Surgery & Local Anaesthesia
- Local anaesthetics: Lidocaine safe dosage (4.4mg/kg), Articaine metabolism, and LAST toxicity signs
- RCS coronectomy guidelines for high-risk third molars and oro-antral communication (OAC) repair
- SDCEP management of patients on anticoagulants (Warfarin INR ≤ 4.0, DOAC morning dose delay)
- Medication-Related Osteonecrosis of the Jaw (MRONJ) risk factors and surgical bone closure
Sample SBA Practice Questions
Sample Question 1 (Paper A)
A patient presents 3 days after lower third molar extraction with severe pain, halitosis, and an empty socket devoid of blood clot. What is the immediate treatment?
- Prescribe 0.2% chlorhexidine mouthwash and review in one week
- Irrigate gently with warm saline and dress the socket with Alvogyl
- Curette the socket walls to provoke fresh bleeding and a new clot
- Prescribe amoxicillin 500 mg three times daily for five days
✅ Correct Answer: Irrigate gently with warm saline and dress the socket with Alvogyl
Explanation: Dry socket is treated conservatively by gentle saline irrigation to clear debris followed by an obtundent dressing (Alvogyl).
Clinical Pearl: Flat pulpal floor perpendicular to occlusal forces provides essential resistance form.
Sample Question 2 (Paper A)
During extraction of an upper molar, a 6mm oro-antral communication (OAC) occurs. What is the appropriate surgical management?
- Give antibiotics, decongestant and sinus precautions alone, with delayed closure if it persists
- Place a resorbable collagen plug and figure-of-eight suture, with antibiotic cover and sinus precautions
- Raise a buccal advancement flap for primary closure, with antibiotic cover and sinus precautions
- Suture the buccal and palatal gingival margins together, with antibiotic cover and sinus precautions
✅ Correct Answer: Raise a buccal advancement flap for primary closure, with antibiotic cover and sinus precautions
Explanation: OACs > 5mm require primary surgical closure (e.g. buccal advancement flap) and sinus precautions under antibiotic cover.
Clinical Pearl: BSP BPE Code 3 indicates probing depth 3.5–5.5mm with WHO probe black band partially visible.
Sample Question 3 (Paper A)
Which muscle space is involved in Ludwig's Angina, a life-threatening bilateral fascial space infection?
- Submandibular and lateral pharyngeal (parapharyngeal) spaces, bilaterally
- Submandibular, sublingual and submental spaces, bilaterally
- Submandibular and sublingual spaces, with retropharyngeal extension
- Sublingual and submental spaces only, sparing the submandibular space
✅ Correct Answer: Submandibular, sublingual and submental spaces, bilaterally
Explanation: Ludwig's angina is a rapidly spreading bilateral cellulitis involving the submandibular, sublingual, and submental spaces, threatening airway patency.
Clinical Pearl: Socransky Red Complex pathogens: P. gingivalis, T. denticola, T. forsythia.
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