Prometric Exam Questions for Oral and Maxillofacial Surgery Specialists 2026: 20 MCQs with Answers on Third Molars, Facial Fractures, Odontogenic Infections, Cysts and Tumours, Oral Cancer, Orthognathic Surgery, TMJ, Implants and Medical Emergencies

The specialist oral and maxillofacial surgery paper (OMS5351 at DHA, and the equivalent SCFHS, QCHP and NHRA papers) is 100 to 150 single-best-answer questions in up to three hours with a pass mark of about 60%. Candidates with an MDS or MS in oral and maxillofacial surgery, an OMFS residency, MOMS RCS, FDSRCS or an Arab Board sit it after the authority confirms the specialist title. Road traffic trauma, high caries rates and a growing implant and orthognathic market shape Gulf OMFS practice, and the paper mirrors that mix of dentoalveolar surgery, trauma, pathology, oncology and reconstruction. This set covers what recurs. The licensing route, including how single-degree and dual-degree surgeons are assessed, is in the oral and maxillofacial surgeon guide.

Dentoalveolar surgery

Question 1

A panoramic radiograph of a lower third molar shows darkening of the root where it crosses the inferior alveolar canal, interruption of the canal's white lines and diversion of the canal. Before extraction the surgeon should:

1. Proceed without further imaging; these signs are irrelevant
2. Recognise the radiographic signs of close proximity to the inferior alveolar nerve, consider CBCT to define the relationship, warn the patient specifically of temporary (about 1 to 5%) and permanent (under 1%) lower lip and chin numbness, and consider coronectomy as an alternative in high-risk vital teeth without caries or mobility
3. Extract under general anaesthesia only
4. Refer for orthodontic extrusion

Answer: B. Lingual nerve injury risk rises with lingual flap retraction; both nerves are documented in the consent for every lower third molar.

Question 2

Four days after a difficult lower molar extraction, a patient has severe throbbing pain, an empty socket with exposed bone, halitosis and no fever or swelling. The diagnosis and management are:

1. Osteomyelitis; six weeks of intravenous antibiotics
2. Alveolar osteitis (dry socket); irrigate gently with warm saline, place a sedative dressing (for example an iodoform or eugenol-based paste) and review every two to three days until pain resolves, with analgesia; antibiotics are not indicated without infection
3. Retained root; re-exploration under general anaesthesia
4. Fracture of the mandible

Answer: B. Smoking, oral contraceptives, traumatic extraction and poor hygiene increase risk; chlorhexidine rinse before and after surgery reduces incidence.

Question 3

A patient on warfarin with an INR of 2.8 needs two simple extractions. The appropriate management is:

1. Stop warfarin for five days before surgery
2. Proceed without interrupting warfarin when the INR is below about 4.0 (checked within 24 to 72 hours), using local haemostatic measures (atraumatic technique, oxidised cellulose or collagen in the socket, sutures, tranexamic acid mouthwash), and avoiding NSAIDs; stopping warfarin risks thromboembolism that outweighs bleeding risk
3. Admit for heparin bridging
4. Give vitamin K the night before

Answer: B. For direct oral anticoagulants, a morning dose may be delayed until after haemostasis for higher-risk procedures per guidance; antiplatelet drugs are not stopped for dental surgery.

Question 4

While elevating an upper first molar root, the surgeon suspects it has been displaced into the maxillary sinus. The correct management is:

1. Leave the root and tell the patient nothing
2. Confirm with radiographs, attempt retrieval through the socket with suction and irrigation if the root is visible and the opening is adequate, otherwise retrieve via a Caldwell-Luc approach or endoscopically, close any oroantral communication (buccal advancement flap or palatal flap if large), and prescribe antibiotics, decongestants and sinus precautions (no nose blowing or straw use)
3. Extract the adjacent teeth to gain access
4. Pack the socket with gauze and discharge

Answer: B. Small oroantral communications under 2 mm may heal spontaneously; those over 5 mm or persisting beyond 48 hours are closed surgically.

Infection

Question 5

A patient has a swelling of the floor of the mouth and submandibular region bilaterally, raised tongue, drooling, trismus, fever and difficulty swallowing. The diagnosis and priority are:

1. Mumps; supportive care
2. Ludwig's angina (bilateral submandibular, sublingual and submental space cellulitis), a threat to the airway; secure the airway early (awake fibreoptic intubation or surgical airway if needed), intravenous antibiotics, surgical decompression and drainage, and removal of the odontogenic source
3. Sialadenitis; sialogogues
4. Allergic reaction; antihistamine

Answer: B. Trismus, dysphagia, stridor, raised floor of mouth and systemic toxicity are the red flags for admission; the lateral pharyngeal and retropharyngeal spaces carry the risk of mediastinitis.

Question 6

Which antibiotic regimen is appropriate for a healthy adult with an odontogenic abscess requiring systemic treatment and no penicillin allergy?

1. Ciprofloxacin alone
2. Amoxicillin (with metronidazole added for severe or anaerobic-predominant infections, or amoxicillin-clavulanate) for about five days, always combined with drainage and removal of the source; clindamycin or azithromycin for penicillin allergy
3. Long-term tetracycline
4. Vancomycin orally

Answer: B. Antibiotics without drainage fail; cultures are taken in severe, hospital-acquired or immunocompromised cases.

Question 7

A patient on intravenous zoledronic acid for bone metastases develops exposed, non-healing bone in the lower jaw eight months after an extraction. The diagnosis and management are:

1. Dry socket; curettage
2. Medication-related osteonecrosis of the jaw (stage 2 if symptomatic with infection); conservative management with antimicrobial mouthrinse, antibiotics for infection, pain control, removal of loose sequestra and avoidance of aggressive surgery, with resection reserved for advanced disease; prevention by completing dental treatment before starting antiresorptives and avoiding extractions where possible
3. Osteoradionecrosis; hyperbaric oxygen
4. Squamous cell carcinoma; biopsy only

Answer: B. Risk is far higher with intravenous antiresorptives for cancer than with oral bisphosphonates for osteoporosis; denosumab and antiangiogenic drugs are also implicated.

Trauma

Question 8

A patient has a fracture of the left mandibular angle and a right parasymphyseal fracture after an assault, with malocclusion and numbness of the left lower lip. The management is:

1. Soft diet and observation
2. Airway and primary survey first, then open reduction and internal fixation with plates (load-sharing miniplate at the angle with the third molar managed according to its condition, and plates at the parasymphysis), restoring occlusion with intermaxillary fixation during surgery, antibiotics for open fractures and a soft diet; the numbness reflects inferior alveolar nerve injury that usually recovers
3. Six weeks of closed reduction with arch bars in all cases
4. Extraction of all teeth in the fracture lines

Answer: B. Angle fractures have the highest complication rate; teeth in the fracture line are removed only if fractured, infected, mobile or preventing reduction.

Question 9

A patient has periorbital bruising, subconjunctival haemorrhage, infraorbital numbness, a step at the infraorbital rim, flattening of the cheek and diplopia on upward gaze. The likely injury and the imaging and management are:

1. Nasal fracture; closed reduction
2. Zygomatic complex fracture with orbital floor involvement; CT with coronal reconstructions, ophthalmological assessment, and open reduction with fixation at the appropriate points (frontozygomatic suture, infraorbital rim, zygomatic buttress) with orbital floor reconstruction where there is entrapment, enophthalmos or a large defect; advise no nose blowing and antibiotics for sinus involvement
3. Le Fort III fracture; immediate tracheostomy
4. Dentoalveolar fracture; splinting

Answer: B. Retrobulbar haemorrhage (a tense proptosed painful eye with falling vision) is a sight-threatening emergency needing immediate lateral canthotomy and cantholysis.

Question 10

Which clinical finding distinguishes a Le Fort II from a Le Fort I fracture?

1. Mobility of the maxillary alveolus alone
2. Mobility of the nasal bridge and maxilla together as a pyramidal segment, with bilateral periorbital bruising, infraorbital nerve paraesthesia and a step at the infraorbital rims; Le Fort I moves only the tooth-bearing maxilla, and Le Fort III separates the whole midface at the zygomaticofrontal sutures and orbits
3. Anterior open bite
4. CSF rhinorrhoea in Le Fort I

Answer: B. CSF leak and cribriform plate involvement are features of Le Fort II and III; the airway, cervical spine and head injury take priority in high-energy midface trauma.

Pathology and oncology

Question 11

A 25-year-old has a painless expansile multilocular "soap bubble" radiolucency of the posterior mandible with root resorption and an unerupted third molar. Incisional biopsy shows an ameloblastoma, follicular type. The management is:

1. Enucleation and curettage alone
2. Segmental or marginal resection with about 1 to 1.5 cm bony margins (depending on cortical involvement), immediate or delayed reconstruction (fibula free flap for large defects), and long-term follow-up because of recurrence; unicystic ameloblastoma confined to the lumen may be treated more conservatively
3. Radiotherapy alone
4. Marsupialisation only

Answer: B. Conventional ameloblastoma recurs in up to 50 to 90% after enucleation alone; it is benign but locally aggressive.

Question 12

A well-defined unilocular radiolucency surrounds the crown of an unerupted lower third molar, attached at the cementoenamel junction, with 8 mm of follicular space. The most likely diagnosis and treatment are:

1. Odontogenic keratocyst; resection
2. Dentigerous cyst; enucleation with removal of the associated tooth (or marsupialisation and later enucleation for very large cysts or where the tooth may be guided into position in young patients), with histological examination of every specimen because keratocysts and ameloblastomas can mimic it
3. Radicular cyst; root canal treatment
4. Ameloblastoma; segmental resection

Answer: B. Odontogenic keratocysts grow anteroposteriorly with little expansion, have a high recurrence rate and are treated with enucleation plus adjuncts (Carnoy's solution, peripheral ostectomy) or marsupialisation; multiple keratocysts suggest Gorlin syndrome.

Question 13

A 60-year-old smoker and shammah (smokeless tobacco) user has a 2.5 cm non-healing ulcer of the lateral tongue with an indurated base and a mobile 2 cm ipsilateral level II lymph node. Biopsy confirms squamous cell carcinoma. The management principles are:

1. Wide excision of the tongue lesion only
2. Staging (clinical examination, CT or MRI of the head and neck, chest imaging, and depth of invasion from biopsy), multidisciplinary planning, and primary surgery with wide excision of the tumour with 1 cm margins and an ipsilateral neck dissection (selective levels I to III, or modified radical with the clinically positive node), reconstruction with a free flap as needed, and adjuvant radiotherapy (with chemotherapy for positive margins or extranodal extension); this is at least stage III disease
3. Radiotherapy alone without staging
4. Observation and smoking cessation

Answer: B. Depth of invasion now drives T staging in the oral cavity (AJCC 8th edition); shammah and other smokeless tobacco products are major oral cancer risk factors in Saudi Arabia and Yemen.

Question 14

Which oral lesion carries the highest risk of malignant transformation?

1. Frictional keratosis
2. Proliferative verrucous leukoplakia and erythroplakia, followed by non-homogeneous (speckled or nodular) leukoplakia, especially on the floor of the mouth, ventral tongue and soft palate, in non-smokers and with epithelial dysplasia on biopsy
3. Geographic tongue
4. Fordyce spots

Answer: B. All persistent white or red lesions without an obvious cause are biopsied after two weeks; oral lichen planus has a low but real transformation risk and is kept under review.

Orthognathic surgery, TMJ and implants

Question 15

A patient with a skeletal Class III deformity is planned for bimaxillary orthognathic surgery. Which statement about the sequence and the key risks is correct?

1. Surgery is performed before any orthodontics
2. Pre-surgical orthodontics decompensates the dentition, a Le Fort I maxillary advancement and a bilateral sagittal split mandibular setback are performed using virtual planning and splints or patient-specific plates, followed by post-surgical orthodontics; the key risks are inferior alveolar nerve paraesthesia after sagittal split (common, usually temporary), bad splits, bleeding, relapse, malocclusion and airway changes
3. The mandible alone is always sufficient
4. Growth must be incomplete at the time of surgery

Answer: B. Surgery is performed after growth is complete except in severe deformities or obstructive sleep apnoea; maxillomandibular advancement is a treatment for selected sleep apnoea patients.

Question 16

A 30-year-old woman has clicking of the right TMJ with intermittent locking, pain on function and reduced opening to 30 mm. MRI shows anterior disc displacement with reduction. The first-line management is:

1. Open joint surgery with discectomy
2. Conservative management: education, soft diet, jaw exercises and physiotherapy, NSAIDs, a stabilisation splint, and management of parafunction and stress, with arthrocentesis or arthroscopy reserved for persistent closed lock or pain unresponsive to conservative care; open surgery is rarely indicated
3. Occlusal equilibration
4. Permanent intermaxillary fixation

Answer: B. Most temporomandibular disorders improve with conservative care; the DC/TMD classification is the diagnostic framework.

Question 17

A patient needs an implant in the upper first molar region with 4 mm of residual bone height below the sinus floor. The appropriate approach is:

1. Place a standard 10 mm implant without grafting
2. A lateral window sinus floor elevation with grafting (autogenous, xenograft or alloplast) with simultaneous or delayed implant placement (delayed usually when residual height is under 4 to 5 mm); a transcrestal (osteotome) approach suits cases with 5 mm or more of bone needing modest elevation; short implants are an alternative in borderline cases
3. A zygomatic implant as first choice
4. Extract the adjacent teeth

Answer: B. Sinus membrane perforation is the commonest complication, managed with collagen membrane repair; sinusitis and graft infection are later risks.

Anaesthesia and emergencies

Question 18

A 70 kg patient has received 10 cartridges (18 mL) of 2% lidocaine with 1:100,000 adrenaline over a long procedure and becomes agitated, then drowsy with twitching. The surgeon recognises:

1. Anxiety; reassure
2. Local anaesthetic systemic toxicity (360 mg given, approaching or exceeding the 7 mg/kg or about 500 mg absolute maximum with adrenaline, and far above the conservative 4.4 mg/kg); stop injecting, call for help, manage the airway and give oxygen, treat seizures with a benzodiazepine, and if cardiovascular collapse occurs start resuscitation and lipid emulsion per protocol
3. Adrenaline reaction; wait
4. Hypoglycaemia; glucose

Answer: B. Articaine 4% with adrenaline has a maximum of about 7 mg/kg (72 mg per cartridge, so about 7 cartridges for 70 kg); aspiration and slow injection reduce intravascular injection.

Question 19

A patient in the dental chair becomes pale, sweaty and bradycardic and loses consciousness briefly after the injection, recovering within a minute when laid flat. The diagnosis and management are:

1. Anaphylaxis; adrenaline
2. Vasovagal syncope, the commonest medical emergency in dental practice; lay the patient flat with legs raised, loosen tight clothing, give oxygen, monitor pulse and blood pressure, and allow recovery before continuing or rescheduling; prevention by reducing anxiety, treating supine and avoiding fasting
3. Hypoglycaemia; insulin
4. Stroke; aspirin

Answer: B. Anaphylaxis presents with urticaria, angio-oedema, bronchospasm and hypotension over minutes and needs intramuscular adrenaline 0.5 mg; every Gulf dental facility must hold an emergency kit and staff must hold BLS.

Question 20

A patient with a prosthetic heart valve needs an extraction and a patient with a hip replacement two years ago needs the same. Which statement about antibiotic prophylaxis is correct?

1. Both need prophylaxis
2. The patient with a prosthetic valve needs prophylaxis (amoxicillin 2 g orally 30 to 60 minutes before, or clindamycin or azithromycin in allergy) because prosthetic valves, previous endocarditis, certain congenital heart diseases and cardiac transplant valvulopathy are the high-risk categories; routine prophylaxis for prosthetic joints is not recommended by current orthopaedic and dental guidance
3. Neither needs prophylaxis
4. Only the hip replacement patient needs prophylaxis

Answer: B. Good oral hygiene reduces bacteraemia more than prophylaxis; some authorities retain prophylaxis for prosthetic joints in immunocompromised patients within the first two years.

How to practise

• Learn the emergencies and their sequences: airway in deep space infection, retrobulbar haemorrhage, local anaesthetic toxicity, anaphylaxis, bleeding on anticoagulants.
• Know the radiographic patterns of cysts and tumours and their definitive treatments.
• Know the staging and margins for oral cancer and the modern Le Fort and mandibular fracture management.
• Practise under time in the Oral and Maxillofacial Surgery bank with the error-log method.

Related sets: general dentistry questions, ENT questions, plastic surgery questions and periodontics questions.

Frequently asked questions

How many questions are in the Prometric oral and maxillofacial surgery exam?

Typically 100 to 150 single-best-answer MCQs in up to three hours, with a pass mark of about 60%, varying by authority.

Which OMFS topics come up most?

Third molar surgery and nerve injury, odontogenic infections and the airway, facial fractures, cysts and ameloblastoma, oral cancer staging, anticoagulated patients and medical emergencies.

Does the exam cover orthognathic and implant surgery?

Yes, at the level of planning principles, sequencing, complications and case selection.

Is a single-degree (dental) OMFS specialist accepted in the Gulf?

Yes at most authorities, with a recognised postgraduate OMFS degree and experience; scope may be defined by the authority, and the guide linked above explains the assessment.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.