Start practicing

Medical Emergencies · patient case question

What do you do?

Patient case: Metformin, interferons, zoledronate and lisinopril — three extractions

Scenario: Patient taking METFORMIN, INTERFERONS, ZOLEDRONATE and LISINOPRIL. HbA1c = 8; BP = 132/92. You need to do THREE EXTRACTIONS.

  1. Extract only the non-restorable teeth in the general practice
  2. Refer to a specialist
  3. Proceed with all three extractions and prescribe antibiotics
  4. Defer indefinitely and place the patient on recall
Show answer and explanation

Correct answer: B. Refer to a specialist

  • A. Limiting extractions to non-restorable teeth is sound MRONJ risk reduction in principle, but the decision and the surgery are best made in a specialist setting for this risk profile.
  • B. Correct per the source key. Multiple extractions in a patient on IV bisphosphonate therapy with additional systemic comorbidity is appropriately referred to an oral and maxillofacial surgeon, ideally with consultation of the prescribing physician regarding the indication and duration of therapy.
  • C. Antibiotic prophylaxis alone does not prevent MRONJ and does not address the underlying risk.
  • D. Indefinite deferral leaves active disease untreated, which itself can precipitate osteonecrosis.

Practice Medical Emergencies questions Medical Emergencies study notes

More Medical Emergencies practice questions