Oral Surgery · patient case question
To which specialist should this patient be referred?
Patient case: Exposed Bone After an Extraction
Patient: 68-year-old male
Chief Complaint: “The bone is showing where they pulled my tooth, and it smells bad.”
Background: Metastatic prostate carcinoma with bone metastases, on monthly intravenous zoledronic acid for 3 years. Tooth #30 extracted 10 weeks ago at another office. No history of head and neck radiation. Non-smoker.
Medications: Zoledronic acid IV monthly · Leuprolide · Calcium and vitamin D
Vital Signs: BP 132/80 mmHg · HR 76 bpm · RR 16 · T 99.1°F
Findings: A 15 mm area of exposed, necrotic-appearing bone at the #30 site with purulent drainage and surrounding erythema. No extraoral fistula. Teeth #29 and #31 are present, sound, and periodontally stable. The patient asks about replacing #30 with an implant once the site heals.
Show answer and explanation
Correct answer: A. Oral and maxillofacial surgeon
- A. Correct. Management requires staging, long-term surveillance, and the capacity to perform resective surgery should the disease progress. Coordination with his oncologist regarding any drug holiday is also part of that referral pathway.
- B. Incorrect. A periodontist manages periodontal and peri-implant disease and performs regenerative and mucogingival surgery. This lesion falls outside that scope.
- C. Incorrect. Prosthetic rehabilitation may eventually be considered, but only long after the osteonecrosis is controlled.
- D. Incorrect. The lesion is at an extraction site, not associated with a pulp. There is nothing endodontic to treat.