Medical Emergencies · patient case question
Which additional laboratory value would best inform your assessment of his healing capacity?
Patient case: Medically complex man requesting extraction of a painful tooth
Patient: Male, 56 years old
Chief complaint: “This tooth kept me awake all night. I want it out today.”
Background: Type 2 diabetes. Prostate cancer treated 2 years ago. Currently taking warfarin, bisphosphonates and antihypertensive medication.
Vital signs / labs: INR 2.4
Current findings: Non-restorable tooth with symptomatic irreversible pulpitis. Patient is insistent that it be removed at this visit.
Show answer and explanation
Correct answer: C. HbA1c
- A. Creatinine matters for drug dosing but is not the key healing predictor in this scenario.
- B. Serum calcium is not the relevant marker here, though it is worth noting bisphosphonates can lower it.
- C. CORRECT. HbA1c reflects average glycaemic control over roughly the preceding three months and is the single best predictor of impaired wound healing and infection risk in a diabetic surgical patient. Combined with bisphosphonate exposure, poor glycaemic control compounds the osteonecrosis concern.
- D. Cholesterol has no bearing on surgical healing.
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