Oral Surgery · patient case question
A patient with a longstanding TMJ disorder wants to stop smoking. Which cessation aid is least appropriate?
Patient case: Third Molar Surgery and Its Complications
demo: 24-year-old female
chief: “The gum over my lower wisdom tooth is swollen and I can barely open.”
history: Smokes 10 cigarettes daily. Takes combined oral contraceptives. Poor oral hygiene.
meds: Combined oral contraceptive pill
findings: Partially erupted #17 with an inflamed, edematous operculum, purulent exudate on pressure, trismus, and tenderness. Extraction is planned. Four days after a previous extraction of #32, she developed severe radiating pain with an empty socket and exposed bone.
Show answer and explanation
Correct answer: C. Nicotine gum, because prolonged chewing loads the joint
- A. Varenicline is an oral tablet with no mechanical demand on the joint.
- B. The transdermal patch requires no jaw activity and is the preferred nicotine replacement route for this patient.
- C. Correct. Nicotine gum requires the repetitive chew-and-park technique for extended periods, which loads an already symptomatic joint and can aggravate myofascial pain.
- D. Bupropion is likewise an oral tablet and places no load on the masticatory system.
Note: External verification against CDC and VA cessation guidance supports nicotine gum as the answer, on the mechanical-loading rationale. Keyed to nicotine gum here.