Oral Surgery · single question
A 67-year-old female on methotrexate and amitriptyline has non-restorable caries on tooth 30 and chooses extraction. The procedure is most likely to result in which complication?
Show answer and explanation
Correct answer: C. Delayed wound healing and poor hemostasis
Methotrexate (MTX) is an immunosuppressant that impairs wound healing by inhibiting rapidly dividing cells (fibroblasts, epithelial cells). Amitriptyline has antiplatelet effects (inhibits serotonin uptake in platelets, reducing platelet aggregation). Together, these medications create risk for DELAYED WOUND HEALING (from MTX) and POOR HEMOSTASIS (from amitriptyline's antiplatelet effects). MRONJ is associated with bisphosphonates and antiresorptives — methotrexate is not an antiresorptive.
- A. INCORRECT. Alveolar osteitis (dry socket) is primarily associated with smoking, traumatic extractions, and oral contraceptive use — not specifically MTX/amitriptyline.
- B. INCORRECT. MRONJ (medication-related osteonecrosis) is associated with ANTIRESORPTIVE agents (bisphosphonates, denosumab, ranelibumab) and antiangiogenic drugs — NOT methotrexate.
- C. CORRECT. Methotrexate impairs wound healing by suppressing rapidly dividing cells (fibroblasts, epithelium). Amitriptyline inhibits platelet aggregation via serotonin reuptake inhibition. Together, delayed wound healing and poor hemostasis are the expected complications.
- D. INCORRECT. Nerve paresthesia after extraction is associated with proximity to the IAN, nerve trauma, or local anesthetic complications — not specifically from MTX/amitriptyline.