Third Molar Extraction Complications — MFDS Part 1 MCQ

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ModerateOral Surgery PrinciplesThird Molar Extraction ComplicationsMFDS Part 1

A 24-year-old fit and well non-smoker undergoes surgical removal of a mesioangularly impacted lower right third molar under local anaesthesia, requiring a buccal flap, bone removal and tooth sectioning. Which of the following is the most common postoperative complication of this procedure?

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Correct answer: B — Alveolar osteitis (dry socket)

Alveolar osteitis is the commonest complication after surgical removal of a mandibular third molar: prevalence is roughly 1–5% after routine extraction but rises to as much as 30% after surgically removed third molars, reflecting flap raising, bone removal and sectioning. Temporary inferior alveolar nerve paraesthesia is the strongest distractor and a mandatory UK consent item, but transient injury typically affects only a few per cent of cases, far fewer than dry socket. Permanent lingual nerve paraesthesia is much rarer still (well under 1% persisting at six months). Mandibular angle fracture is rare and largely confined to deeply impacted teeth in older or atrophic mandibles. Haemorrhage needing hospital admission is uncommon in a fit, non-anticoagulated patient. Oroantral communication is a maxillary, not mandibular, complication and was therefore removed as an invalid option.

Reference: Dry Socket Prevalence and Risk Factors in Third Molar Extractions: A Prospective Observational Study (introduction — prevalence of dry socket), 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11032735/ (UK context: Faculty of Dental Surgery, RCS England, Parameters of care for patients undergoing mandibular third molar surgery, 2021, https://www.rcseng.ac.uk/-/media/files/rcs/fds/guidelines/3rd-molar-guidelines--april-2021.pdf)