Oral Surgery · patient case question
You explain that the tooth cannot simply be taken out today. The principal reason is:
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: B. Bisphosphonate therapy and the associated risk of medication-related osteonecrosis of the jaw
- A. Diabetes impairs healing and matters, but it is not the reason the extraction cannot proceed as a routine procedure.
- B. CORRECT. BISPHOSPHONATES are the standing concern. Extraction is the single strongest local trigger for MEDICATION-RELATED OSTEONECROSIS OF THE JAW (MRONJ). Risk depends on route and duration — intravenous, high-dose oncology regimens carry far greater risk than oral therapy for osteoporosis — so the drug, dose, route and duration must all be established, and the patient consented specifically to this risk.
- C. The history describes treated prostate cancer, not active chemotherapy. Note that antiresorptive therapy is frequently given in prostate cancer for bone metastases, which raises the suspicion this is high-dose IV therapy.
- D. Antihypertensives are not a barrier to extraction.
Note: Establish route and duration before deciding. IV antiresorptive therapy for malignancy carries substantially higher MRONJ risk than oral therapy for osteoporosis.