Extractions and minor oral surgery

Pain and anxiety control

End of session test

1. A patient attended for the extraction of a lower right second molar tooth and then re-attended 3
days later with severe pain in the area. On questioning, the patient admitted to starting to
smoke again as soon as the local anaesthetic wore off after the extraction. Which one of the
following conditions is most likely to be diagnosed?
A Localised osteitis
B Oroantral fistula
C Retained root
D Reactionary haemorrhage
E Surgical emphysema

2. During the extraction of a grossly carious upper right first molar tooth, the crown disintegrates
and is removed in pieces leaving the three roots still to be extracted. Which instrument is
correctly used to help split the roots apart from each other, so that they can be simply extracted
separately?
A Bone rongeurs
B Coupland’s chisel
C Cryer’s elevator
D Luxator
E Periosteal elevator

3. A surgical procedure is planned to remove a retained root which is present in the alveolar bone
with soft tissue coverage over it. Which of the following instruments is unlikely to be required
for this procedure?
A Aspirator
B Bone rongeurs
C Periosteal elevator
D Scalpel kit
E Suture pack

4. A patient has attended with poor oral hygiene in several areas, due to hyperplastic gingivae.
The patient is epileptic and has been taking the anti-seizure drug Epanutin for many years, and
a BPE recording shows all sextants scoring 1. Which one of the following procedures is most
likely to be carried out to assist this patient with their oral hygiene regime?
A Alveolectomy
B Flap surgery
C Frenectomy
D Gingivectomy
E Operculectomy

5. There are many minor oral surgery procedures that may be carried out in the dental workplace.
What is the correct term used for the removal of a section of tissue to be sent for pathological
analysis and diagnosis?
A Alveoplasty
 B Biopsy
C Cyst removal
D Frenectomy
E Gingivoplasty

6. Many local anaesthetic cartridges contain a vasoconstrictor which acts to extend the period
of anaesthesia by constricting the surrounding blood vessels and preventing the removal of
the agent from the area by the bloodstream. Which one of the following commercially
available local anaesthetics has the greatest risk when if administered to pregnant women?
A Articaine
B Lidocaine
C Mepivacaine
D Prilocaine 3%
E Prilocaine 4%

7. The gas cylinders used for inhalation sedation sessions are colour-coded and pin indexed
to prevent the patient receiving an overdose of nitrous oxide or insufficient oxygen during
their treatment. What is the colour used to indicate a nitrous oxide cylinder?
A Black
B Black/white shoulder
C Blue
D Blue/white shoulder
E White

8. There are various methods of reducing a patient’s anxiety of undergoing dental treatment.
Which technique relies on the patient becoming unconscious and therefore being
unresponsive to any painful procedure that is carried out?
A Acupuncture
B Conscious sedation
C General anaesthesia
D Hypnosis
E Premedication

9. Where local anaesthesia techniques are carried out, the dental workplace is expected to
check and have knowledge of patient’s medical history and any existing medical conditions
or medications, that may interact with the local anaesthetic solution. Which one of the
following medications can induce hypertension as a side effect, and therefore local
anaesthetic with adrenaline should be avoided?
A Ibuprofen
B Midazolam
C Asthma medication
D Hormone replacement therapy
E Antihistamines
 10. Many local anaesthetics are available for use in dentistry, supplied in either glass or plastic
cartridges which contain various constituents. Which one of the following constituents is
present to act as a carrying agent and makes up the bulk of the cartridge contents?
A Anaesthetic
B Buffering agent
C Preservative
D Sterile water
E Vasoconstrictor

End of session test - answers

1. A patient attended for the extraction of a lower right second molar tooth and then re-attended 3
days later with severe pain in the area. On questioning, the patient admitted to starting to
smoke again as soon as the local anaesthetic wore off after the extraction. Which one of the
following conditions is most likely to be diagnosed?
A Localised osteitis
B Oroantral fistula
C Retained root
D Reactionary haemorrhage
E Surgical emphysema
This painful condition develops within 2–3 days post extraction whenever the clot has been
disturbed or infection has developed in the bony socket.

2. During the extraction of a grossly carious upper right first molar tooth, the crown disintegrates
and is removed in pieces leaving the three roots still to be extracted. Which instrument is
correctly used to help split the roots apart from each other, so that they can be simply extracted
separately?
A Bone rongeurs
B Coupland’s chisel
C Cryer’s elevator
D Luxator
E Periosteal elevator
Although often used as an elevator, the correct use of this instrument is to help dissect or
trisect multirooted teeth during extraction.
3. A surgical procedure is planned to remove a retained root which is present in the alveolar
bone with soft tissue coverage over it. Which of the following instruments is unlikely to be
required for this procedure?
A Aspirator
B Bone rongeurs
C Periosteal elevator
D Scalpel kit
E Suture pack
This instrument is used to remove bone, but as the retained root is only covered by soft
tissue in this case, its requirement is unlikely.

4. A patient has attended with poor oral hygiene in several areas, due to hyperplastic gingivae.
The patient is epileptic and has been taking the anti-seizure drug Epanutin for many years, and
a BPE recording shows all sextants scoring 1. Which one of the following procedures is most
likely to be carried out to assist this patient with their oral hygiene regime?
A Alveolectomy
B Flap surgery
C Frenectomy
D Gingivectomy
E Operculectomy
This is the surgical removal of hyperplastic gingivae to aid in maintaining a high standard of
oral hygiene.

5. There are many minor oral surgery procedures that may be carried out in the dental workplace.
What is the correct term used for the removal of a section of tissue to be sent for pathological
analysis and diagnosis?
A Alveoplasty
B Biopsy
C Cyst removal
D Frenectomy
E Gingivoplasty

6. Many local anaesthetic cartridges contain a vasoconstrictor which acts to extend the period
of anaesthesia by constricting the surrounding blood vessels and preventing the removal of
the agent from the area by the bloodstream. Which one of the following commercially
available local anaesthetics has the greatest risk when if administered to pregnant women?
A Articaine
B Lidocaine
C Mepivacaine
D Prilocaine 3%
E Prilocaine 4%
Contains felypressin which can induce labour in pregnant women.

7. The gas cylinders used for inhalation sedation sessions are colour-coded and pin indexed
to prevent the patient receiving an overdose of nitrous oxide or insufficient oxygen during
their treatment. What is the colour used to indicate a nitrous oxide cylinder?
A Black
B Black/white shoulder
C Blue
 D Blue/white shoulder
E White

8. There are various methods of reducing a patient’s anxiety of undergoing dental treatment.
Which technique relies on the patient becoming unconscious and therefore being
unresponsive to any painful procedure that is carried out?
A Acupuncture
B Conscious sedation
C General anaesthesia
D Hypnosis
E Premedication
General anaesthesia renders the patient unconscious, with loss of all sensation and all
reflexes. It is only carried out in the hospital environment.

9. Where local anaesthesia techniques are carried out, the dental workplace is expected to check
and have knowledge of patient’s medical history and any existing medical conditions or
medications, that may interact with the local anaesthetic solution. Which one of the following
medications can induce hypertension as a side effect, and therefore local anaesthetic with
adrenaline should be avoided?
A Ibuprofen
B Midazolam
C Asthma medication
D Hormone replacement therapy
E Antihistamines

10. Many local anaesthetics are available for use in dentistry, supplied in either glass or plastic
cartridges which contain various constituents. Which one of the following constituents is
present to act as a carrying agent and makes up the bulk of the cartridge contents?
A Anaesthetic
B Buffering agent
C Preservative
D Sterile water
E Vasoconstrictor