Oral Surgery Midterm

Which is not a mechanism to control hemostasis in surgery:

A. electrocautery

B. vasoconstcitors

C. procoagulants

D. ice

D

A Minnesota retractor is best used for what reason?

A. Extract maxillary molars

B. Incise through soft tissue

C. Protect soft tissue gingival flaps

D. Retract the tongue

C

Which statement best describes the cowhorn forceps (87)

A. Designed with two pointed, heavy beaks that enter a bifurcation

B. Designed with straight handle and beaks that are obliquely downward

C. Designed with beaks smooth and narrow and only contact at the tips

D. Designed with broad and offset beaks from the handle

A

What is the main difference between a needle holder and a hemostat?

A. A hemostat has a curved narrow tip while a needle holder has a broad straight tip

B. A hemostat can be utilized for suturing while a needle holder holds the suture needle

A

Which statement regarding dental elevators is false?

A. Dental elevators provide luxation to a tooth making it easier to extract

B. Dental elevators provide mobility to fractured segments of teeth during

extraction making it easier to remove

C. A curved dental elevator is most commonly used to luxate teeth

D. A triangular (east west) is most commonly used to remove fractured root tips adjacent to a root socket

C

When extracting multiple teeth on a patient what should be completed first?

A. multi-disciplinary treatment plan

B. post-op instructions

C. mandibular teeth

D. type and screen

A

When performing full arch maxillary extractions, what should you consider?

A. how will the patient be prosthodontically restored

B. if a palatal torus is present

C. if exostoses are present

D. if an alveoloplasty should be performed

E. all of the above

E

A 16 year old female presents to your office with 3 days of pain of the left mandible. You complete a thorough history and examination. On panoramic imaging you note a grossly decayed tooth #19 with decay through the furcation. How will this tooth best be removed/extracted?

A. routine forcep extraction

B. with a #150 forcep

C. with an envelope flap

D. with an envelope flap and removal of the distal and mesial roots individually

D

When extracting a maxillary molar that is unable to be removed routinely with a forcep, what should you do?

A. section the tooth between the mesial and distal roots

B. section the tooth between the mesiobuccal, distobuccal and palatal roots

C. section the tooth in the shape of an X

D. section the tooth into the max sinus

B

Which forcep would be recommended when extracting mandibular anterior teeth

A. #60 forcep

B. #40 forcep

C. Cowhorn forcep

D. Ash forcep

D

Which of the following are the major motions utilized when extracting a tooth with a forcep?

A. Rotational forceps

B. Buccal

C. Apical

D. Palatal

E. All of the above

E

The role of the bite block is what?

A. To allow dislocation of the TMJs

B. To prevent arthritis of the TMJs

C. To allow forces to the TMJs

D. To stabilize the forces to the TMJs

D

When extracting a mandibular molar which patient position should be utilized?

A. Head turned away from the operator

B. Mandible parallel to the floor

C. 60-100 degrees from the floor

D. Operator at the 4 o'clock position

B

When designing an envelope flap, what should this flap ideally look like?

A. broadly based

B. narrow based

C. Width of one tooth

D. 5 corners

A

What type of flap is utilized most commonly when extracting teeth?

A. Partial thickness

B. Submucosal

C. Full thickness

D. Semi-lunar

C

When developing an envelope flap where should your releasing incision be placed?

A. At the right angle of the tooth

B. At the palatal aspect of the tooth

C. Never uses releasing incisions

D. At 5 corners

A

You are performing a dental extraction on tooth #4. You note significant decay at the level of the alveolar bone on imaging. You attempt to extract #4 with a #150 forcep but the tooth continues to fracture. What should you consider as your next step?

A. Extract tooth #5 to gain access to tooth #4

B. Envelope flap followed by removal of a trough of bone

C. Semi-lunar flap followed by removal of a trough of bone

D. Placement of forceps onto gingiva to extract teeth

B

Which is an accurate measure to attempt to reduce the incidence of alveolar osteitis peri-operatively?

A. Chlorhexidine

B. Decadron

C. Ibuprofen

D. Bacitracin

A

A 16 year old female with a past medical history of asthma presents for extraction of tooth #19. She currently takes Albuterol and birth control pills. She has no known drug allergies. You complete a routine dental extraction of tooth #19. A week later she calls your office complaining of severe pain radiating to her ear. She denies any swelling, fevers, trismus or difficulty breathing. What do you think is the likely cause of her pain?

A. Alveolar osteitis

B. Buccal space abscess

C. Masticator space abscess

D. Submandibular space abscess

A

After extracting a maxillary central incisor in an otherwise healthy patient, what should the general dentist do in order to ensure hemostasis post-operatively?

A. Cauterize the extraction site

B. Place gelfoam in all extraction sites

C. Apply pressure with gauze

D. Irrigate with saline

C

40-year old male has history of dental pain and subperiosteal abscess associated with tooth #13. This patient presents to your office and you note a grossly decayed tooth #13 without swelling. You surgically remove #13. Three days post-op the patient calls your office with noted facial swelling and a fever of 101.5. He denies neck swelling, difficulty swallowing, or speaking. What should you suggest to the patient?

A. Appoint for a same day evaluation

B. Call in antibiotics to his pharmacy

C. Call in pain medication to his pharmacy

D. Suggest to return to his already scheduled follow-up in 4 days

A

Which medication is contraindicated in the third trimester of pregnancy?

A. ibuprofen

B. acetaminophen

C. Codeine

D. Penicillin

A

What is a manifestation of hyperventilation syndrome?

A. tachypnea

B. hypoxia

C. acidosis

D. hypersalivation

B

Dead space is a result of:

A. foreign material remaining in the wound.

B. tight sutures which cause wound necrosis.

C. removing tissue in the depths of the wound.

D. inadequate surgical hemostasis with bleeding into wound.

C

Healing of an extraction socket is by:

A. primary intention.

B. secondary intention.

C. tertiary intention.

B

Surgical instruments in sterilized bags should be used absolutely before:

A. 4 months.

B. 8 months.

C. 12 months.

D. 16 months.

C

Which of the following is standard protocol for a surgical consent?

A. Be obtained on the day of surgery.

B. List all complications

C. Use lay language

D. Be obtained by surgeon or surgeon's nurse

C

Which retractor is designed specifically to retract the tongue?

A. Minnesota

B. Austin

C. Weider

D. Selden

C

Which of the following describes a needle holder?

A. Longer, thinner beak than hemostat

B. Beak has parallel grooves to permit grasping needle

C. Curved beak to facilitate access to posterior oral cavity

D. Locking handle

D

The maximum wound strength achieved after a wound heals is:

A. 75%

B. 85%

C. 90%

D. 95%

B

When extracting a mandibular tooth the occlusal plane should be:

A. parallel to the floor

B. 45 degrees to the floor

C. 60 degrees to the floor

D. perpendicular to the floor

A

What is the most significant benefit for applying apical forces when extracting a tooth?

A. Disrupts the PDL

B. Minimizes risk of root fracture

C. Decreases likelihood of buccal plate fracture

D. Ensures that the tooth is firmly engaged

B

Which of the following is a strong indication for an open extraction?

A) Crowned tooth

B) Multi-rooted tooth in the posterior maxilla

C) Short clinical crowns with evidence of severe attrition

D) Tooth with associated periapical granuloma

C

When using a straight elevator to extract a tooth, the inferior portion of the blade rests on the alveolar bone and the:

A. occlusal portion of the blade is turned toward the tooth being extracted.

B. apical portion of the blade is turned toward the tooth being extracted.

C. handle can be moved occlusally as the instrument is rotated to help elevate the tooth.

D. handle can be moved with slow, strong forceful turning in the posterior direction to elevate the tooth.

A

Which is a condition that must exist for a tooth root to be left in the alveolar process during an extraction?

A. Tooth must have been absent of periodontal pathology

B. Root must be deeply embedded on bone so that it does not erupt

C. Root fragment must be less than 5 mm in length

D. Root fragment must not be mobile

C

Which is a basic principle of flap design?

A. An envelope flap usually extends one tooth anterior to the surgical region

B. Leaving the periosteum attached to the bone optimizes wound healing

C. Flap design should ensure wound closure is achieved over intact bone

D. An envelope flap for tooth removal should be supra-periosteal

B

Which agent promotes platelet aggregation?

A. Gelfoam

B. Surgical

C. Avitene

D. Bone wax

C

Which technique will minimize injury to the TMJ during the extraction of a mandibular tooth?

A. Positioning the occlusal plane parallel to the floor

B. Use of a bite block

C. Minimize the degree of incisal opening

D. Administer an anti-inflammatory medication post-operatively

B

Which of the following is *true*?

A. Trismus of the masticator muscle results from needle penetration associated with an inferior alveolar nerve injection

B. Postoperative swelling reaches its maximum in about 48 hours

C. Ecchymosis usually occurs in older patients because of their weaker intracellular attachments

D. Typical signs of infection develop in 1 to 2 days post-operatively

B

What schedule of drug is hydrocodone and acetaminophen?

A. I

B. II

C. III

D. IV

C

An intraseptal alveolplasty is indicated when:

A. the alveolar ridge has an undercut to the depth of the labial vestibule.

B. there is excessive bone in the depth of the vestibule.

C. there is limited keratinized attached tissue.

D. the alveolar ridge is narrow with adequate height.

A

When performing a vestibuloplasty with floor of mouth lowering what muscle is apically positioned?

A. Mentalis

B. Genioglossus

C. Mylohyoid

D. Digastric

C

Which technique for excising a labial frenum is used to minimize the potential decrease in he amount of vestibular ablation seen with the other techniques?

A. Laser ablation

B. Z - plasty

C. Linear excision

D. Submucosal vestibuloplasty

B

A full thickness palatal finger flap is an example of an axial pattern flap; because it receives its blood supply by a known vessel that runs within the base of the flap.

A. the first part of the statement is true and is supported by the second part of the statement

B. the first part of the statement is false; however the second part of the statement is true

C. the first part of the statement is true; however, it is not supported by the second part of the statement

D. both parts of the statement are false

A

The application of helistat or avitene to the surgical site as opposed to gelfoam has the advantage in promoting hemostasis because of:

A. acting as a scaffold

B. chemical cauterization

C. contains collagen and activates the coagulation cascade

D. occluding bony channels within the socket

C

Note: surgicel results in chemical cauterization

Which of the following is NOT part of the differential diagnosis of acute onset chest pain?

A. angina pectoris

B. dyspepsia

C. hypoventilation

D. intercostals muscle spasm

C

Moist heat is a more efficient manner of heat sterilization than dry heat achieving sterilization with both a reduced temperature and time necessary to kill spores, BECAUSE moist heat oxidizes cell proteins and dry heat causes destructive protein coagulation.

A. the first part of the statement is true and is supported by the second part of the statement

B. the first part of the statement is false; however the second part of the statement is true

C. the first part of the statement is true; however, it is not supported by the second part of the statement

D. both parts of the statement are false

C

Which elevator has a triangular tip?

A. Potts

B. Cryer

C. Crane pick

D. Weider

B

Apical forces are initially applied to the forcep when extracting a tooth, WHICH lowers the center of the tooth's rotation reducing the incidence of a coronal root fracture

A. the first part of the statement is true and is supported by the second part of the statement

B. the first part of the statement is false; however the second part of the statement is true

C. the first part of the statement is true; however, it is not supported by the second part of the statement

D. both parts of the statement are false

C

-this action will lower the center of the tooth's rotation reducing the incidence of a *apical root fracture*

The following is an indication for performing a Dean's or intrraseptal alveoloplasty.

A. excessive alveolar height

B. bony exostoses

C. buccal undercut

D. high muscular attachments

C

Which of the following findings will NOT potentially increase the difficulty of extracting a tooth?

A. hypercementosis

B. root dilacerations

C. root divergence

D. apex in close proximity to the neurovascular bundle

D

The lingual plate of bone associated with tooth #18 (mandibular 2nd molar) is generally thicker than the buccal plate of bone; so the 2nd mandibular molar can be more easily removed with stronger buccal than lingual pressure.

A. both components of the statement are correct

B. first part is correct; second part is false

C. first part is false; second part is true

D. both parts of the statement are false

D

A radiograph must show the:

A. crown of a tooth

B. only the roots

C. the entire crown and roots of a tooth

D. entire jaws (ie. panorex) every time

C

What determines the degree of difficulty of an extraction?

A. only the root form

B. the condition of the crown and configuration of the root

C. mucosal conditions

D. children's extractions are usually more difficult

B

When discussing the consent form with a patient, the risks, benefits, and _________ are discussed.

A. alternatives to the procedure

B. every single potential complication possible

C. only the possibility of death

D. only the possibility of bleeding

A

The classification of an oral cavity wound is:

A. clean

B. dirty

C. clean-contaminated

D. contaminated

C

An incision that is made perpendicular to the surface:

A. impedes wound healing

B. results in an increased likelihood of wound dehiscence

C. is associated with a higher potential for tissue necrosis

D. minimizes the potential for injury to underlying structures

D

Which elevator is specifically designed to facilitate the removal of the apical 2/3 of the mesial root of a mandibular first molar?

A. Cryer

B. Potts

C. Miller

D. Crane pick

A

Which of the following is most accurate?

A. a curved needle is held approximately 3/4 of the distance b/w the tip and base of the needle

B. a cutting portion of a cutting needle extends 1/3 the length of the needle

C. the needle holder is held with the thumb and the 4th finger through the holes and with the index finger along the length of the needle holder

D. a needle that enters the tissue obliquely will make the smallest possible hole in the mucosal flap.

B

Which of the following fractured root tips should be removed?

A. a root tip associated with class 3 fracture

B. a deeply embedded root tip

C. a root tip associated with an acute pericoronitis

D. a loose root tip in close proximity to the inferior alveolar nerve

D

The application of surgicel to the surgical site is unique in its hemostatic action compared to other agents in that it has which effect?

A. provides a scaffold

B. chemical cauterization

C. contains collagen and activates the coagulation cascade

D. occludes bony channels within the socket

B

Which of the following is a basic principle pertinent to creating a surgical flap for dentoalveolar surgery?

A. a vestibular incision is the preferred approach for extracting an apically positioned tooth near the piriform ridge

B. the base of an envelope flap with both an anterior and posterior vertical release should never exceed its width

C. the posterior extent of an envelope flap should be at least 1 tooth posterior to the tooth that is being extracted

D. the vertical release of an envelope flap should be placed on the direct facial aspect of the tooth

C

In regards to extraction forceps, which of the following is most appropriately paired?

A. forcep #150 = extraction of mandibular molar

B cowhorn forceps = tooth extracted by squeezing handles together and luxating tooth buccal-lingual

C. ash forcep = horizontal hinge and vertically positioned handle

D. forcep beaks = designed to adapt to root structure and not to crrown

D

Which of the following agents use for hemostasis promotes platelet aggregation?

A. surgicel

B. collagen

C. gelfoam

D. topical thrombin

B

Which situation is LEAST likely to require an open extraction?

A. a patient with a history of bruxism

B. older patient vs younger patient

C. multi-rooted tooth with convergent roots

D. teeth with extensive carious crown and root caries

C

Which force is (most frequently) applied last by the forceps in extracting a (mandibular) tooth?

A. apical

B. tractional

C. rotational

D. lateral

B

Which of the following is most accurate relative to patient positioning when performing surgery in the standing position?

A. the height of the chair should be such that the patient's mouth is slightly above the operator's elbow

B. the height of the chair should be such that the patient's mouth is approximately 18 inches from the operator's field of view

C. patients are generally more reclined for the extraction of a maxillary tooth than a mandibular tooth

D. when removing a maxillary posterior tooth, the patient should have their head turned slightly away from the side of the extraction

C

An Allis tissue forcep is used to:

A. hold tissue during suturing

B. grasp tissue for flap reflection

C. grasp tissue that is being excised

D. stabilize tissue for dissection

C