CASE 9 — Patient on Loestrin (norethindrone/ethinyl estradiol), smoking 2 packs/year, HbA1c=6. Tooth #19 is non-restorable. What might most complicate post-extraction pain?

Correct answer: A. Smoking

• A. Smoking is the #1 risk factor for DRY SOCKET (alveolar osteitis) — the most common post-extraction complication causing severe delayed pain. Smoking impairs healing via vasoconstriction, clot disruption from negative intraoral pressure (sucking), and chemical toxins. This is the most significant post-extraction pain complication in this patient.
• B. Estradiol increases clotting risk (dry socket risk exists) but is less directly associated with pain management complications.
• C. HbA1c of 6 is borderline normal/pre-diabetic range — not a significant post-extraction pain complicator at this level.
• D. Norethindrone (progestin) also increases clotting risk but is less directly tied to post-extraction pain.