Oral Surgery

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. A general dentist should establish a good working relationship with a specialist in oral surgery for consultations and surgery techniques.

a) true
b) false

2. It is important to plan your surgery before you begin the process.

a) true
b) false

3. If a patient demands to have his tooth extracted when it could be saved with root canal therapy, it is okay to extract the tooth.

a) true
b) false

4. A tooth should be extracted on the first visit even if infection and swelling are present in the site.

a) true
b) false

5. Pain from a tooth can be the result of infection, clenching, or nerve exposure.

a) true
b) false

6. Teeth should not be extracted unless there is a valid reason for doing so.

a) true
b) false

7. Anesthetic injections into the gingiva do not need to be aspirated because blood vessels do not exist in the gingiva.

a) true
b) false

8. The painless infiltration method of giving an injection includes the following statements:

a) The labial tissue is allowed to fall on the needle.
b) Only a small amount of anesthetic is given initially.
c) After the tissue is numb, the gingiva is blanched with anesthetic.
d) The first two statements are correct.
e) All three statements are correct.

9. The goal of the extraction is to remove the tooth without excessive injury to the alveolar bone.

a) true
b) false

10. In a simple extraction of an anterior tooth pressure can be applied in the following directions:

a) labially
b) lingually
c) twisted side to side
d) All of the statements are correct.

11. To avoid fracturing of the labial alveolar bone over the anterior teeth during the extraction process, the following precautions should be observed:

a) During the extraction process, more pressure should be applied toward the lingual to loosen the tooth.
b) Opening the contacts and twisting the tooth mesially and distally will preserve the labial alveolar bone.
c) Placing your finger over the labial alveolar bone will help in determining how much pressure to give.
d) All of the above statements are correct.
e) Only the first two statements are correct.

12. After the tooth is extracted it is a good idea to squeeze the extraction site close with a two- by-two gauze.

a) true
b) false

13. When the mandibular first bicuspids are extracted, the following statements are correct:

a) The mesial and distal contacts are removed to allow the forceps to apply a twisting pressure.
b) The buccal, lingual, and twisting pressures are used to loosen the tooth and to find the path of extraction.
c) The first mandibular bicuspid is extracted with a twist pulling action.
d) All of the above statements are correct.
e) None of the statements is correct.

14. During the extraction of the first maxillary bicuspid, the following statements are correct:

a) The thin curved root of the first maxillary bicuspid allows only buccal and lingual pressure in the extraction process.
b) The tooth is loosened before the extraction attempt is made.
c) The extraction of a first maxillary bicuspid is made with constant pressure straight out after the tooth has been loosened with the buccal and lingual pressure.
d) All of the above statements are correct.
e) Only the first two statements are correct.

15. Fracture of the maxillary bicuspid roots occurs when the path of extraction is ignored.

a) true
b) false

16. A fractured first maxillary bicuspid root should be eased out of the alveolar bone with root picks and explorers because forceps tend to fracture the thin roots.

a) true
b) false

17. A single-rooted mandibular molar is one of the easiest to extract because the shape of the roots converge to a point.

a) true
b) false

18. The blanching injection technique can be started on the lingual side of the tooth when the tongue is numb from the inferior alveolar injection.

a) true
b) false

19. The following statements are correct when the single-rooted mandibular molar is extracted:

a) The tooth needs to be free of attached gingiva before it can be extracted.
b) Using the mandibular forceps, the tooth is moved buccal-lingually and twisted mesial distally until the path of extraction is found.
c) Both statements above are correct.
d) None of the statements is correct.

20. The following is 'true when you extract a bi-rooted mandibular molar:

a) The roots are curved making a forceps removal difficult.
b) Rocking a bi-rooted tooth to the buccal can fracture the buccal bone.
c) The buccal-lingual bur cut to separate the roots needs to pass through the floor of the pulp chamber, but not through the buccal or lingual walls of the tooth.
d) All of the statements above are correct.
e) Only the first two statements are correct.

21. After the roots are separated in a bi-rooted mandibular molar extraction the following statements are correct:

a) It is easier to extract the distal root first because it is usually less curved and the path of extraction is toward the mesial.
b) The split may need to be enlarged if it interferes with the path of extraction for the distal root.
c) If the curvature of the distal root is extreme, the root may need to be split before it can be extracted.
d) All of the above statements are correct.
e) Only the first two statements are correct.

22. In a tri-rooted mandibular molar extraction the following statements are correct:

a) The mesial root is the one usually bi-rooted.
b) The distal root is extracted first after the roots are separated with a bur cut.
c) The mesial bi-roots are loosened before the roots are split.
d) An attempt to extract a firm root with a pedo-anterior forceps will probably fracture the root at the alveolar bone.
e) All of the above statements are correct.

23. If the mesial roots will not move in a tri-rooted mandibular extraction, the following may be the reason:

a) The path of extraction may be wrong.
b) The fractured edges of the root may be lodged in the alveolar bone.
c) The mesial roots are fused except for apical one-third.
d) All of the statements are correct.
e) None of the statements is correct.

24. Excessive force to push the root in a tri-rooted extraction will only result in fracturing the root and possibly the alveolar bone.

a) true
b) false

25. When extracting a mandibular third molar with distal curved roots, the following statements are correct:

a) The path of extraction will be to the distal.
b) The tissue around the tooth needs to be free to avoid tearing the tissue upon extraction.
c) The distal portion of the tooth may need to be removed before the tooth can be extracted.
d) All of the above statements are correct.

26. The mandibular third molar with a mesial-curved root and a straight distal root need to be split before it can be extracted.

a) true
b) false

27. The following statements are correct for the extraction of a mandibular third molar with a straight distal root:

a) The straight distal root is twisted, and moved buccal-lingually to find the path of extraction.
b) The mesial root is extracted with an elevator.
c) The mesial root may need to be split to allow room for the path of extraction.
d) To remove fractured roots below the alveolar bone requires patience and time.
e) All of the above statements are correct.

28. The following statements are correct for an impacted mandibular third molar:

a) The lack of room is the usual cause of third molars becoming impacted.
b) It is good to plan your extraction from the X-rays before the surgery is started.
c) The mandibular third molar is usually distal and slightly buccal to the second molar.
d) All of the above statements are correct.
e) None of the above statements is correct.

29. The following is 'true of an impacted mandibular third molar locked below the distal of the second molar with distally curved roots:

a) Enough bone needs to be removed over the impacted tooth to expose the crown and three millimeters of root.
b) The crown portion of the impacted tooth needs to be free of the second molar before it can be extracted.
c) The 557 bur groove through the crown portion of the impacted tooth needs to go deep, but it should not leave the tooth.
d) All of the above statements are correct.
e) Only the first two statements are correct.

30. If the fractured crown portion of the impacted mandibular third molar will not move, it can be cut with a 557 bur a second time to ease its removal.

a) true
b) false

31. The following statements are 'true regarding the extraction of an impacted mandibular two-rooted third molar with distally curved roots that is locked below the distal of the second molar:

a) After the crown portion of the impacted tooth is fractured off another groove is placed in the floor of the pulp chamber between the mesial and distal roots.
b) The distal root’s path of extraction is usually mesial and apically.
c) The mesial root’s path of extraction is usually mesial and incisally.
d) A groove is never placed on the mesial side of the mesial root because the risk of disrupting the inferior alveolar nerve is too high.
e) All of the above statements are correct.

32. Before extracting a horizontal boney impacted tooth, one should consider referring the case to a specialist.

a) true
b) false

33. The following statements are correct when taking an X-ray of an impacted third molar:

a) After the patient closes on the snap-a-ray holding the X-ray film, the patient is instructed to open slightly as the snap-a-ray is moved further distally.
b) The patient is numbed before the X-ray is taken.
c) The patient holds his breath while the X-ray is taken.
d) All of the above statements are correct.
e) Only the first two statements are correct.

34. The tissue covering the lingual alveolar bone beside the impacted horizontal tooth is very thin and fragile.

a) true
b) false

35. The impacted horizontal tooth is found slightly buccal to the midline of the alveolar ridge.

a) true
b) false

36. A totally impacted tooth is usually surrounded with a sac of tissue allowing it to move easily once room is provided for it.

a) true
b) false

37. If the split crown portion of the horizontal impacted tooth is too large to be removed through the alveolar bone opening, it can be split a second time.

a) true
b) false

38. The following statements are correct in buccal-lingual horizontal alveolar bone impaction:

a) The root is exposed instead of the crown portion as in the distal-mesial impaction.
b) The exposed portion of the root is removed after separating it from the crown and apical portions with two splits.
c) The crown portion may need to be split to reduce its size before it can be removed through the alveolar bone opening.
d) All of the above statements are correct.
e) All of the above statements are incorrect.

39. The following statements are correct concerning post-operative problems:

a) Most post-operative problems can be avoided by not allowing the patient to leave the office until the patient is swallowing correctly and the bleeding has stopped.
b) Once the patient is home a phone call should be placed to see how the patient is doing.
c) Most post-operative pain is the result of the patient clenching the teeth surrounding the surgery site.
d) Excessive rinsing of the mouth with water will remove the blood clot and leave exposed bone and pain.
e) All of the above statements are correct.

40. The following statements are correct concerning an anterior supernumerary tooth extraction:

a) Supernumerary teeth usually lay lingual and apical to the maxillary anterior central teeth.
b) A rise in the boney palate will indicate the location of a supernumerary tooth
c) The central incisors should be fully developed before the supernumerary tooth is removed.
d) All of the above statements are correct.
e) The first two statements are correct.

41. Two supernumerary teeth are sometimes easier to extract than one because the teeth are smaller allowing for more movement in the socket.

a) true
b) false

42. The following statements are correct when a cuspid is exposed for an orthodontic clasp and gold chain:

a) The cuspid may be impacted in the labial alveolar bone above the deciduous cuspid or it may be buried deep in the palatal bone.
b) An envelope of tissue separates the tooth from the bone.
c) The crown does not need to be fully exposed to place the orthodontic bracket and gold chain.
d) All of the above statements are correct.
e) Only the first two statements are correct.

43. A palatal impaction can be located by taking X-rays and probing for a protrusion of bone.

a) true
b) false

44. Extra awareness of the incisal canal’s location is important to avoid injury to the nerve.

a) true
b) false

45. The following statements are correct when the first maxillary posterior molar is extracted:

a) The first maxillary molar is usually three-rooted:
b) Pressure is applied buccal-lingually to loosen the tooth
c) The #557 bur makes a mesial-distal groove through the pulp chamber but not through the mesial and distal contacts.
d) The #557 bur makes a groove through the bifurcation of the mesial and distal buccal roots before they are separated with the flat-bone chisel.
e) All of the statements are correct.

46. In the extraction process of the maxillary posterior molar buccal roots the pedo-anterior forceps is not used until the roots are loosened by the elevators.

a) true
b) false

47. If the maxillary first molar is loosened prior to splitting it, there is less chance of fracturing the roots upon extraction.

a) true
b) false

48. The following statements are correct for the maxillary first molar extraction:

a) The buccal roots are extracted before the lingual root is attempted.
b) The usual path of extraction for the lingual root is toward the buccal.
c) The lingual root needs to be loosened with elevator and root picks before the pedo- anterior forceps is used.
d) The lingual root can be twisted to extract it.
e) All of the above statements are correct.

49. The maxillary molar lingual root will fracture when:

a) The extraction was attempted without prior loosening it.
b) The root is decayed to the alveolar bone.
c) Improper splitting with the bur results in a fracture of the root.
d) All three of the above statements are correct.
e) Only the second statement is correct.

50. The following statements are correct when extracting a badly decayed lingual root:

a) A trough can be placed with a #557 bur beside the root to give a leverage point if the floor of the maxillary sinus allows this.
b) A dry decayed root will not take any heavy pressure without fracturing.
c) A trough can continue around the root to ensure there are not any sharp edges of the root embedded in the alveolar bone.
d) All of the above statements are correct.
e) Only the second statement is correct.

51. The following statements are correct for the drawstring suture:

a) The drawstring suture draws up the tissue from four corners and is tied off.
b) The sutures will keep the tissue approximated to the alveolar bone and can be re moved easily.
c) The suture should be kept in place for three to four days and then removed.
d) All of the above statements are correct.
e) None of the above statements is correct.

52. A dry socket is the result of the extraction site losing its blood clot:

a) true
b) false

53. The following statements are 'true for maxillary third molar extractions:

a) This can be an easy extraction if the roots curve toward the buccal.
b) Elevating the third molar with a straight distal root toward the distal will fracture the distal buccal alveolar bone.
c) The tooth should be loosened before the extraction is attempted with a forceps.
d) All of the above statements are correct.
e) Only the first statement is correct.

54. One of the most difficult teeth to extract is a decayed root canaled maxillary molar.

a) true
b) false

55. The treatment of choice for a sinus exposure is to close the site and allow the sinus membrane to heal itself from the inside.

a) true
b) false

56. A sinus exposure can be closed with either a vertical flap or a horizontal flap.

a) true
b) false

57. A gold foil technique should be considered if the sinus exposure is difficult to close.

a) true
b) false

58. The following statements are 'true for multi-extractions:

a) Extracting teeth from gingiva filled with granulation tissue should be limited to one quadrant at a time.
b) Granulation tissue absorbs large amounts of the anesthetic.
c) Teeth are extracted in order taking the tooth most distally first.
d) All of the above statements are 'true.
e) The first statement is 'false.

59. A large amount of the bleeding will be controlled once the excessive granulation tissue is removed in multi-extractions.

a) true
b) false

60. The following statements are 'true when multi-extractions result in sharp edges of alveolar bone pushing through the healed tissue:

a) The sharp boney ridges are the result of the uneven absorption of thin and thick alveolar bone.
b) At a later appointment a tissue flap will be necessary to remove the sharp ridges before the denture can be placed.
c) Sharp ridges seem to be more prevalent when surgery is done in the presence of granulation tissue.
d) All of the statements are correct.
e) None of the statements is correct.

61. The following statements are correct concerning a submandibular tori:

a) The submandibular tori grows from the base and pushes out into the alveolar bone.
b) Submandibular tori can be found in children four and fives years of age.
c) Submandibular tori has no adverse complications to the patient other than its size.
d) All of the above statements are correct.
e) Only the first two statements are correct.

62. The following statements are correct for the removal of a submandibular tori:

a) The tissue over the tori is very thin and can tear easily.
b) The alveolar bone is reduced with a #2 round bur and a bone file.
c) Finger pressure against the lingual side of the tissue flap will help the tissue to reattach to the alveolar bone.
d) All of the above statements are correct.
e) Only the first two statements are correct.

63. The mandibular tori removal should be a separate appointment from the quadrant extractions because it will give you the opportunity to smooth the sharp edges resulting from the resorption of the alveolar bone.

a) true
b) false

64. The two-by-two gauze pressure technique will stop the bleeding and help the tissue to reattach to the alveolar bone.

a) true
b) false

65. The maxillary tori is not removed unless it is very large or it interferes with the placement of the maxillary denture.

a) true
b) false

66. The plastic splint is placed after the maxillary tori is removed to hold the tissue tight against the palatal bone.

a) true
b) false

67. The following statements are correct when removing the maxillary tori:

a) The first incision with the #15 blade is distal-mesial across the center of the tori.
b) You should avoid extending the incision into the soft palate.
c) There are usually no vessels in the boney tori.
d) All of the above statements are correct.
e) Only the first two statements are correct.

68. The following statements are correct for an apioectomy:

a) The patient is covered with a regimen of antibiotics before the surgery to control the infection.
b) The vertical incision is placed on the gingiva mesial to the surgical site and mesial to the embrasure.
c) A root canal file is measured against the X-ray to determine the length of the tooth.
d) All of the above statements are correct.
e) Only the first two statements are correct.

69. Usually the periapical cyst wraps around the apical portion of the root and extends incisally several millimeters.

a) true
b) false

70. The following statements are correct concerning an apioectomy:

a) Mandibular bicuspid apioectomies should be referred to a specialist.
b) Excessive swelling may occur above the surgical wound when infection is encountered in the surgery.
c) Swelling and dark blue blanches are the result of broken vessels, infection, and the rough handling of the tissues.
d) All of the above statements are correct.
e) Only the first two statements are correct.

71. The reverse bevel technique is used instead of gingivectomy in most cases, but the gingivectomy is still beneficial in reducing gingiva hyperplasia.

a) true
b) false

72. The following statements are correct concerning a gingivectomy:

a) Scaling and curettage needs to be done prior to the surgery to remove the granulation and necrotic tissues.
b) The surgery should be kept in the attached gingiva.
c) Surgery in the anterior section needs to be continuous to achieve better results.
d) All of the statements are correct.
e) Only the first two statements are correct.

73. The following statements are correct concerning the use of an electro-surge in a gingivectomy procedure:

a) The “L”-shaped tip is used for clean up to remove tissue tags and shape the remaining tissue.
b) An aspirator should be used in conjunction with an electro-surge to reduce the smell of burning tissue.
c) A thin loop-shaped tip should be used to remove tissue in the posterior molar area.
d) Practice moves with the thin loop-shaped tip are preferred before it is used for cutting the tissue.
e) All of the above statements are correct.

74. The periodontal dressing for a gingivectomy should incorporate as much powder as possible before it is applied to the wound.

a) true
b) false

75. The following statements are correct concerning a periodontal reverse bevel flap:

a) The surgical procedure is used to re-contour the vertical bone loss around peri odontal-involved teeth, and to remove the periodontal pocket by reattaching the gingiva.
b) This procedure removes the periodontal pocket, but it will also leave the tooth with a root exposure above the tissue.
c) Antibiotic therapy needs to be started before surgery to insure the area is free of infection.
d) Only the first two statements are correct.
e) All of the above statements are correct.

76. The following statements are correct for the mandibular second deciduous molar:

a) The usual path of extraction is to the buccal, but this will leave a gaping tissue wound.
b) The tooth should be split with a buccal-lingual groove and extract the mesial and distal roots separately.
c) The mesial and buccal roots are very thin and can easily break off in the alveolar bone.
d) When probing for a thin-fractured root, you may find the tooth bud instead of the root.
e) All of the above statements are correct.

77. The maxillary lip is lifted to detect the frenum movement between the teeth. If there is no movement, the surgery may not be necessary.

a) true
b) false

78. It is mandatory to obtain written permission from the patient before the surgery is started.

a) true
b) false

79. Any questions regarding the patient’s health history should be referred to the patient’s physician.

a) true
b) false

80. A good relationship with a specialist will give the general dentist confidence to attempt more complicated surgery procedures.

a) true
b) false