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ORAL SUREGRY REVISION ACTUAL EXAM NEWSET VERSION -
2025/2026- QUESTIONS AND VERIFIED ANSWERS (100%
SUCCEESS)
What are the clinical features of cellulitis? painful, diffuse and brawny swelling overlying skin is red, tense and shiny usually associated with trismus, cervical lymphadenopathy, malaise and pyrexia swelling is a result of oedema rather than pus What is ludwig's angina? this is cellulitis involving the tissue spaces on both sides of the floor of the mouth it involves the sublingual, submandibular and submental facial spaces the infection is rapidly progressing What is an abscess? a pathological cavity filled with pus and lined by pyogenic membrane What is the management of an acute alveolar abscess? establish drainage of pus this can be done by RCT
alternative to this is XLA to gain adequate drainage What is cellulitis? it is a spreading infection of connective tissue typical of streptococcal organisms also known as phlegmon it spreads through the tissue spaces between the facial muscles and usually results from virulent and invasive organisms What is the most common aetiology of ludwig's angina? dental infection in the lower molars, mainly the second and third which accounts for over 90% of the cases What are the predisposing factors of ludwig's angina? diabetes oral malignancy dental caries alcoholism malnutrition immunocompromised status What is cavernous sinus thrombosis?
What is osteomyelitis? inflammation of the medullary cavity of a bone caused by infection it is quite rare but seen particularly in pts who are immunocompromised due to local or systemic factors What are the clinical features of acute osteomyelitis? pain tenderness swelling in the affected area symptoms are usually the same as on an acute dental infection the mandible is more frequently affected than the maxilla where the body or the lower ramus of the mandible is affected an important symptom is numbness over the chin as a result of inferior alveolar nerve involvement What are the radiological features of acute osteomyelitis? this does not usually present on a radiograph before 10 days the earliest sign is rarefying osteitis it can extend through a large area of bone, involving inferior dental canal and lower cortex of the mandible bone scintigraphy or MRI is more sensitive to early changes in the medullary cavity
What is the management of acute osteomyelitis? Benzylpenicillin or clindamycin and metronidazole are normally started they are altered as necessary when the results of pus sensitivity testing have come back the pt may require hospital admission for incision and drainage but it is preferable to limit any dentoalveolar surgery to extraction of the grossly mobile and non- vital teeth antibiotics should be continued for at least 2 weeks after control of the acute infection What is chronic osteomyelitis? the natural course is that acute osteomyelitis develops into chronic osteomyelitis with pus accumulation and the formation of islands of necrotic bone (sequestra) What are the predisposing factors for chronic osteomyelitis? depressed immune or inflammatory response diabetes long term corticosteroid use bone abnormalities like paget's disease cemento-osseous dysplasia What are the clinical features of chronic osteomyelitis? pain and swelling but it is likely less severe than acute form
a reduction in vascularity, secondary to endarteritis obliterans and damage to the osteocytes as a consequence of ionising radiotherapy can result in radiation associated osteomyelitis or osteoradionecrosis the mandible is much more frequently effected that the maxilla due to it being less vascular pain may be severe and there may be pyrexia the overlying oral mucosa often appears pale due to radiation damage scar tissue will also be present at the tumour site, often in close relation to the necrotic bone What are the radiographical features of osteoradionecrosis? it appears as rarefying osteitis within which islands of opacity (sequestra) are seen pathological features may be visible in the mandible What is the pathology of osteoradionecrosis? the affected bone shows features similar to those of chronic osteomyelitis grossly the bone may be cavitated and discoloured with the formation of sequestra acute inflammatory infiltrate may be present in the background of chronic inflammation, characterised by granulation tissue around the nonvital trabeculae blood vessels show areas of endothelial denudation and obliteration of their lumina by fibrosis fibroblasts in the irradiated tissue lose capacity to divide and often become binucleated and enlarged
What is the management of osteoradionecrosis? prevention of osteoradionecrosis is essential pts who require radiotherapy for the management of head and neck cancer should ideally have teeth of doubtful prognosis extracted at least 6 weeks before treatment begins however a delay in the start time to the radiotherapy in unacceptable and if teeth are extracted only within a couple weeks of treatment osteoradionecrosis may still result surgical management of osteoradionecrosis is similar to osteomyelitis when extraction of teeth is required in pts who have had radiotherapy to the jaws a specialist opinion should be sought sometimes the changes can be extensive which may necessitate jaw resection to remove all the necrotic bone What factors increase the risk of osteoradionecrosis? dose of radiation area of mandible irradiated surgical trauma involved in dental extraction pt factors like age and nutrition have a bearing on wound healing and will also influence the risk What drugs increase the risk of MRONJ? bisphosphonates
history of current or prior treatment using anti-resorptive and anti-angiogenic drugs exposed bone in the jaws which have been present for more than 8 weeks no previous history of radiotherapy What are the radiographic signs of MRONJ? plain radiographic appearance are identical to those of osteoradionecrosis CBCT may offer improved sensitivity over plain radiographs permeating destruction of the ramus, condyle and coronoid notch with detached fragments is an example of what can be seen What is the pathology of MRONJ? the bone often becomes black or dark green in colour due to the products of bacterial colonies forming in the marrow space once the necrotic bone becomes exposed to the oral cavity microscopically the surfaces of non-vital bone are scalloped due to osteoclastic action the osteocyte lacunae are empty and in later stages the bone matrix collagen breaks down granulation tissue may also form at the interface between vital bone and dense chronic active inflammatory reaction is seen sequestration and transmucosal elimination is often found
What is the management of pts who are high risk of MRONJ? prevention of the condition is essential special care should be taken with any pt attending the dentist who is or has undergone treatment with any of the mentioned drugs when an extraction or other surgical treatment is required the wisest course of action is to refer the pt to a specialist modification or brief cessation may be considered in consultation with the treating physician and the pt any surgery should be undertaken as atraumatically as possible and pts should be reviewed regularly after surgery What is the management of MRONJ? the management is similar to osteoradionecrosis combination of antibiotics and careful surgery along with cessation of medication use hyperbaric oxygen therapy may also have value immediate reconstruction of any resection using non-vascularised or vascularised bone may be problematic as necrotic bone may develop at the recipient site What is endarteritis obliterans? it is used to describe the process of internal (intimal) proliferation within a blood vessel it causes obliteration of the lumen resulting in the cessation of blood flow it can arise as a result of several inflammatory processes but it is an important feature of radiation damage
postoperative swelling trismus fracture of teeth excessive bleeding dry socket (alveolar osteitis) postoperative infection osteomyelitis damage to soft tissues damage to nerves opening in the maxillary sinus loss of tooth loss of tooth fragment fracture of the maxillary tuberosity dislocation of the mandible fracture of the jaw displacement of the tooth into the airway surgical emphysema What is dry socket? a blood clot may inadequately form or be broken down and the exposed bone is extremely painful and sensitive to touch What are the predisposing factors to dry socket?
smoking surgical trauma the vasoconstrictor added to LA solution oral contraceptives history of radiotherapy What is the management of dry socket? reassuring the pt that the correct tooth has been extracted irrigation of the socket with warm saline or CHX mouth rinse to remove any debris dressing the socket to protect it from painful stimuli using resorbable alvogyl paste, an iodoform dressing or bismuth, iodoform and paraffin paste (BIPP) or lidocaine gel on ribbon gauze - this needs to be removed and replaced over 2 or 3 weeks What is surgical emphysema? air may enter soft tissues, producing characteristic crackling sensation on palpation this can happen if a mucoperiosteal flap has been raised What should radiological assessment of impacted teeth cover? type and orientation of impaction and the access to tooth crown size and condition root number and morphology
What is osteointegration? the healing of bone around an implant so that there is direct anchorage of the implant that is then maintained during functional loading without the growth of fibrous tissue at the bone-implant interface The root of which tooth is most often displaced into the maxillary antrum during forceps extraction? the palatal root of the maxillary first molar tooth is most frequently dislodged into the maxillary antrum during forceps extraction What is a stafne's cavity? a depression into the cortex may form around the submandibular salivary gland during development and it can give rise to a radiolucent area at the angle of the mandible it is important to know that this is a normal structure which appears below the inferior alveolar nerve canal on radiographs to avoid confusion with bone cysts What causes fibrous dysplasia? a mutation in the GNAS1 gene What is fibrous dysplasia?
normal bone is replaced with fibrous tissue which in turn undergoes gradual calcification monostotic (single bone) and polyostotic (multiple bones) types are seen What percentage of those affected by fibrous dysplasia have the polyostotic form of the disease? around 30% What is an acute alveolar abscess? A common dental emergency facing the dentist is a patient with an acute alveolar abscess What are the clinical features of an acute alveolar abscess? severe pain which is not well localised affected tooth is painful to touch when the abscess follows periapical periodontitis tooth is non-responsive to sensibility testing tooth is carious upon examination pus may exudate from the gingival margin trismus and cervical lymphadenopathy are signs of local spread of infection pyrexia and tachycardia are signs of systemic toxicity Radiographic signs of an acute alveolar abscess
What is the pathology of fibrous dysplasia? initially bone is replaced by cellular fibrous tissue within which as the disease progresses irregular islands and fine trabeculae of metaplastic woven bone develops as the lesion matures so too does the connective tissue, becoming more collagenous while the bone is remodelled to a lamellar pattern the lesional tissue merges with adjacent normal tissue What are the radiological signs of fibrous dysplasia? enlargement of bone altered trabecular pattern generally poorly defined margins initially the affected area appears radiolucent, reflecting fibrous tissue content as bone forms the lesion becomes more radiopaque it is described as ground glass appearance due to a notable trabecular pattern where teeth are present there is loss of lamina dura mandibular lesions sometimes have defined margins What are the radiological signs of cemento-ossifying fibroma?
in the early stages the predominant fibrous components means that is appears like a cyst, well defined and corticated radiolucency with time radiopaque foci appear and these increase in number and size until the lesion becomes predominantly radiopaque a thin radiolucent line often remains around the radiopaque centre teeth in the path of the lesion may be resorbed or displaced the margins of the juvenile forms may not be as well defined What is the management of cemento-ossifying fibroma? surgical enucleation of the lesion is usually adequate What is paget's disease of the bone? this is when there is abnormal bone formation and resorption of the bone it is a chronic disorder which causes bones to grow larger and become weaker than normal What is cemento-ossifying fibroma? it is classified as a fibro-osseous lesion of the jaws it commonly presents as a progressively growing lesion that can attain an enormous size with resultant deformity if left untreated it defined as an osteogenic neoplasm
