Medical Emergencies · patient case question
For which reason is referral necessary before proceeding with the extraction?
Patient case: Denture wearer with uncontrolled systemic disease requiring extraction
Patient: Adult denture wearer requiring an extraction
Chief complaint: Requests removal of a broken-down tooth; also reports burning under the upper denture.
Background: Hypertension and diabetes, both treated with medication. Has worn the same maxillary prosthesis for many years and does not remove it at night.
Vital signs / labs: Blood pressure 150/100 mmHg. HbA1c 7.5%
Current findings: On removing the prosthesis, the palatal mucosa in the bearing area shows a pebbly, cobblestone appearance.
Show answer and explanation
Correct answer: B. Because of the hyperglycaemia
- A. Proceeding without addressing either finding would be poor practice.
- B. An HbA1c of 7.5% indicates imperfect but not extreme glycaemic control, and this is the value the recall identified as the trigger for medical consultation before surgery, given impaired healing and infection risk in the diabetic surgical patient.
- C. Prophylaxis is unrelated to the decision to refer.
- D. A defensible alternative. 150/100 is Stage 2 hypertension under the 2017 ACC/AHA guideline. It is generally NOT an absolute bar to a simple extraction — the usual deferral threshold is around 180/110 — but it does warrant medical follow-up.
Note: ⚠️ Contested item. Both the glycaemic and the blood pressure findings are abnormal and arguably warrant referral. The source keyed hyperglycaemia. Note for the exam: 150/100 is Stage 2 hypertension (2017 ACC/AHA — Stage 2 begins at 140/90), and the deferral threshold for elective care is usually cited around 180/110.
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