Membership of the Joint Dental Faculties (MJDF) Oral Surgery and Dental Emergencies Syllabus

Oral Surgery and Dental Emergencies syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Oral Surgery and Dental Emergencies in Membership of the Joint Dental Faculties (MJDF), not a summary of it.

1. 1

   Exodontia and Minor Oral Surgery

   4 topics

   • Principles of tooth extraction
     • Elevators, luxators and forceps technique
     • Management of fractured roots
   • Surgical extraction and flap design
   • Third molar assessment and management
     • NICE guidance on removal
     • Coronectomy and nerve injury risk
   • Suturing and post-operative instructions
2. 2

   Surgical Complications

   5 topics

   • Post-extraction haemorrhage management
   • Dry socket (alveolar osteitis)
   • Oro-antral communication and fistula
   • Inferior alveolar and lingual nerve injury
   • Medication-related osteonecrosis of the jaw (MRONJ)
3. 3

   Odontogenic Infections

   4 topics

   • Spread of dental infection
     • Fascial spaces of the head and neck
     • Ludwig's angina and airway risk
   • Management of acute dental abscess
   • Antimicrobial prescribing and stewardship
   • Recognition of severe infection requiring referral
4. 4

   Dental and Maxillofacial Trauma

   4 topics

   • Management of dental hard tissue and pulp injuries
     • Crown and root fractures
     • Luxation injuries
   • Avulsion and replantation protocols
   • Splinting techniques and follow-up
   • Assessment of facial and jaw fractures

Oral Surgery and Dental Emergencies flashcards for Membership of the Joint Dental Faculties (MJDF)

20 of 50 cards from the Oral Surgery and Dental Emergencies deck — real questions with worked answers.

1. What three intra-operative forces are used to deliver a tooth during simple (forceps/elevator) extraction?

   Apical (seating the forceps and severing PDL fibres), buccal/lingual rocking (expanding the alveolar bone), and rotational forces, combined with controlled traction to deliver the tooth along the path of least resistance.

2. Which teeth are best suited to rotational extraction forces and why?

   Single conical-rooted teeth, especially upper incisors and lower premolars, because rotation around the long axis tears the PDL without needing significant bucco-lingual expansion.

3. Define the principle behind using an elevator: what is the mechanical action?

   Elevators act as a lever, wheel-and-axle, and wedge to expand bone and luxate the tooth, applying force against a solid bony point (not the adjacent tooth) to mobilise it from the socket.

4. What is a key contraindication to applying elevator force against an adjacent tooth?

   It can luxate, fracture, or damage the adjacent tooth; the buccal alveolar bone or a purchase point on the tooth being extracted should be the fulcrum instead.

5. List the standard indications for a surgical (transalveolar) extraction rather than a simple extraction.

   Heavily restored/root-filled brittle teeth, hypercementosis or divergent/curved roots, ankylosis, dense surrounding bone, retained roots, fractured roots, and unerupted or partially erupted teeth.

6. What are the three principles of designing a mucoperiosteal flap?

   It should have a broad base (wider than the free margin) to preserve blood supply, be full-thickness (mucoperiosteal) to expose bone, and be large enough for access while avoiding vital structures, with margins resting on sound bone.

7. Name two common flap designs used in surgical extraction of teeth.

   The two-sided (triangular) flap with one relieving incision, and the three-sided (trapezoidal/envelope-with-two-relieving-incisions) flap; a simple envelope (sulcular) flap with no relieving incision is also used.

8. Why should relieving incisions avoid bony prominences such as the canine eminence and the mental foramen region?

   To prevent flap dehiscence over prominences, avoid damage to the mental nerve, and ensure the incision lies over sound bone for support and healing.

9. Which classification system describes the angulation of impacted lower third molars?

   Winter's classification — mesioangular, distoangular, vertical, horizontal (also transverse/inverted), describing the long axis of the third molar relative to the second molar.

10. What does the Pell and Gregory classification assess for impacted mandibular third molars?

    Depth of impaction relative to the occlusal/cervical line of the second molar (levels A, B, C) and the relationship to the anterior border of the ramus / available space (classes 1, 2, 3).

11. Which third molar angulation is generally easiest to remove and which is most difficult?

    Mesioangular impactions are typically the easiest to remove; distoangular impactions are usually the most difficult because the tooth is angled into the ascending ramus.

12. List the radiographic signs on a plain film that indicate close proximity of a lower third molar to the inferior alveolar canal.

    Darkening (banding) of the root, deflection/diversion of the root, narrowing of the root, interruption/loss of the white tramlines of the canal, diversion of the canal, and narrowing of the canal — these warrant CBCT assessment.

13. What is a coronectomy and when is it indicated?

    Deliberate removal of the crown of a lower third molar leaving the roots in situ, indicated when roots are intimately related to the IAN canal to reduce the risk of inferior alveolar nerve injury; contraindicated if the tooth is mobile or has apical infection.

14. According to NICE guidance, what is the main indication for removing an impacted third molar?

    Therapeutic removal is indicated for pathology — e.g. unrestorable caries, recurrent pericoronitis (typically a second or subsequent episode), cysts, untreatable pulpal/periapical pathology, fracture in the tooth, or resorption; prophylactic removal of disease-free teeth is not recommended.

15. What suture material and needle type are most commonly used for intra-oral mucosal closure?

    Resorbable sutures such as polyglactin 910 (Vicryl) or plain/chromic gut, typically 3/0, on a reverse-cutting curved needle (e.g. 3/8 circle); non-resorbable silk is also used but requires removal.

16. State the rule of thumb for suture bite placement from the wound edge.

    Place the needle entry approximately 2–3 mm from the wound margin on each side, passing through full thickness of the flap, and space sutures so the wound edges are apposed without tension or blanching.

17. List five standard post-extraction instructions given to a patient.

    Do not rinse for the first 24 hours; avoid hot food/drinks, vigorous exercise, alcohol and smoking; bite on a gauze pack if bleeding recurs; after 24 hours use warm salt-water rinses; take analgesia as needed and contact the clinic if heavy bleeding, swelling, or severe pain develops.

18. What are the three categories of cause for post-extraction haemorrhage?

    Local factors (soft tissue tears, residual granulation tissue, bone vessels, AV malformations), systemic/medical factors (inherited bleeding disorders, liver disease, thrombocytopenia), and drug-related factors (anticoagulants such as DOACs/warfarin, antiplatelets, etc.).

19. Outline the stepwise local measures to control post-extraction bleeding.

    Apply pressure with a damp gauze pack bitten for ~20 minutes; if it continues, give LA with a vasoconstrictor, pack the socket with a haemostatic agent (oxidised cellulose/collagen), suture to compress the socket, and use adjuncts such as tranexamic acid mouthwash; refer if uncontrolled.

20. For a patient on warfarin needing an extraction, what INR threshold allows treatment in primary care, and should warfarin be stopped?

    Treatment can proceed without stopping warfarin if the INR is below 4.0 (ideally checked within 24–72 hours), using local haemostatic measures; do not interrupt warfarin for simple dental extractions.

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