NBDE Oral Surgery 1 — Questions and Answers
Question 1: What is the most common local complication following mandibular third molar extraction?
- Inferior alveolar nerve paresthesia
- Dry socket (alveolar osteitis) (Correct answer)
- Mandibular fracture
- Oroantral communication
Correct answer: Dry socket (alveolar osteitis)
Alveolar osteitis (dry socket) is the most common post-extraction complication, occurring in 2–5% of all extractions and up to 30% of mandibular third molar extractions.
Question 2: The inferior alveolar nerve block anesthetizes the mandibular teeth but does NOT anesthetize which tissue in the molar region?
- Pulp of mandibular molars
- Labial mucosa at the mental foramen
- Buccal gingiva of mandibular molars (Correct answer)
- Mandibular canal contents
Correct answer: Buccal gingiva of mandibular molars
The buccal gingiva of the mandibular molars is innervated by the long buccal nerve, which requires a separate buccal nerve block injection.
Question 3: Dry socket (alveolar osteitis) typically becomes symptomatic within how many days after extraction?
- 1–2 days
- 3–5 days (Correct answer)
- 7–10 days
- 14–21 days
Correct answer: 3–5 days
Dry socket typically presents 3–5 days post-extraction when the blood clot disintegrates, leaving exposed alveolar bone and causing severe, radiating pain.
Question 4: Which of the following is the most significant risk factor for developing dry socket after tooth extraction?
- Age over 60 years
- Smoking tobacco (Correct answer)
- Taking low-dose aspirin
- History of hypertension
Correct answer: Smoking tobacco
Smoking is the most significant risk factor for dry socket because nicotine impairs healing and the negative oral pressure from inhaling can mechanically dislodge the clot.
Question 5: The primary treatment for dry socket (alveolar osteitis) consists of:
- Antibiotics and systemic analgesics alone
- Re-extraction and primary soft tissue closure
- Gentle socket irrigation and placement of a medicated dressing (Correct answer)
- Surgical debridement under general anesthesia
Correct answer: Gentle socket irrigation and placement of a medicated dressing
Treatment involves irrigating the socket to remove debris and placing a medicated dressing such as alvogyl or iodoform gauze to relieve pain and protect exposed bone while healing occurs.
Question 6: Which instrument is primarily used to section an impacted mandibular third molar during surgical extraction?
- Straight forceps (No. 151)
- Cowhorn forceps (No. 16)
- Surgical handpiece with round or fissure bur (Correct answer)
- Periosteal elevator alone
Correct answer: Surgical handpiece with round or fissure bur
Removal of impacted third molars typically requires a surgical handpiece with a bur to remove overlying bone and section the tooth, as forceps alone cannot deliver a fully impacted tooth.
Question 7: Ludwig's angina is a bilateral rapidly spreading cellulitis that primarily involves which fascial spaces?
- Infratemporal and pterygomandibular spaces
- Submandibular, sublingual, and submental spaces (Correct answer)
- Buccal and masseteric spaces
- Parapharyngeal and retropharyngeal spaces
Correct answer: Submandibular, sublingual, and submental spaces
Ludwig's angina involves the bilateral submandibular, sublingual, and submental spaces, producing a board-like induration of the floor of the mouth with potential airway compromise.
NBDE Oral Surgery 1
What is the most common local complication following mandibular third molar extraction?