Dental MCQ
Drugs the patient is already on · Pharmacology · INBDE Patient Cases

Drugs the Dentist Meets in Medical History INBDE Patient Cases

By Dr. Isaac Sun, DDS

9 ADA INBDE-format patient cases on drugs the dentist meets in medical history. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

9 patient cases45 linked questionsADA INBDE formatFull distractor explanations

Nine ADA INBDE-format patient cases on the drugs the dentist meets in the medical history: anticoagulants and a routine extraction (continue warfarin/DOACs with local hemostasis), ACE inhibitor angioedema (bradykinin-mediated; airway-first management), the classic gingival enlargement triad of phenytoin/cyclosporine/calcium channel blockers (with tacrolimus as a substitute for cyclosporine), chronic corticosteroids and the stress-dose question (routine dentistry usually does not need stress dosing), bisphosphonate/denosumab MRONJ prevention through pre-therapy dental optimization, chairside hypoglycemia from sulfonylureas and insulin (with SGLT2 euglycemic DKA and GLP-1 aspiration cautions), chemotherapy mucositis and cytopenia (5-FU/methotrexate, ANC and platelet checks before invasive work), SSRI-related bleeding tendency and bruxism (avoid tramadol), and a composite real-world polypharmacy patient illustrating that the medication review is the highest-yield dental pharmacology safety intervention. This capstone module covers anticoagulants, antiplatelets, antihypertensives, statins, diabetes medications, corticosteroids, bisphosphonates and denosumab, immunosuppressants, chemotherapy, chronic NSAIDs and PPIs, and SSRIs.

Case Coverage Map
What each case is testing
Anticoagulants and a routine extraction:
Continue warfarin/DOACs for simple extractions with local hemostasis; DOAC reversal agents; INR-raising antibiotics; coordinate for higher-bleeding-risk surgery.
ACE inhibitor angioedema in a dental patient:
Bradykinin (not histamine) angioedema; airway-first management; stop the drug; lifelong ACE inhibitor avoidance after angioedema.
Phenytoin, cyclosporine, and a calcium channel blocker:
Classic gingival enlargement triad; plaque control + medication review (tacrolimus alternative); gingivectomy for residual fibrotic overgrowth.
Chronic corticosteroids and the stress-dose question:
HPA suppression; routine dentistry usually does NOT need stress dosing; stress-dose for severe stress only; adrenal crisis recognition.
Bisphosphonates, denosumab, and MRONJ prevention:
IV cancer-dose vs oral osteoporosis risk; complete bony procedures BEFORE therapy; atraumatic technique on therapy; denosumab RANKL vs bisphosphonate matrix.
Chairside hypoglycemia from diabetes medications:
Sulfonylurea + insulin hypoglycemia, oral glucose vs IM glucagon, SGLT2 euglycemic DKA peri-procedural caution, GLP-1 aspiration risk.
Chemotherapy mucositis and cytopenia before dental work:
5-FU/methotrexate mucositis, ANC and platelet check before invasive work, supportive measures, defer elective work in cytopenic nadirs.
SSRIs, bleeding tendency, and bruxism:
Platelet serotonin depletion bleeding, SSRI/SNRI bruxism, avoid tramadol (serotonin syndrome), occlusal appliance plus physician coordination.
The medication review as the high-yield intervention:
Composite real-world polypharmacy patient: apixaban + metoprolol + amlodipine + metformin + empagliflozin + alendronate + omeprazole + sertraline, each changing the chairside plan.
Patient case: Anticoagulants and a routine extraction
0 of 5 answered, 0 correct
Patient
Male, 72 years old
Chief Complaint
Needs a non-restorable mandibular molar extracted; on warfarin (alternate visit: apixaban) for atrial fibrillation.
Background and/or Patient History
  • Atrial fibrillation on warfarin (or apixaban) with INR/anti-Xa in range
  • Routine single-tooth extraction planned
  • Question of stopping vs continuing the anticoagulant
Allergies
NKDA
Medications
  • Warfarin (or apixaban)
Current Findings
  • Indication for an extraction in an anticoagulated patient
  • Standard local hemostasis plan
  1. Question 1
    Moderate
    For a simple single-tooth extraction on warfarin in range, the standard approach is to:
  2. Question 2
    Moderate
    Local hemostatic measures include:
  3. Question 3
    Hard
    On apixaban (a direct factor Xa inhibitor), the rapid-onset/offset profile means that:
  4. Question 4
    Moderate
    An antibiotic interaction in this patient that especially raises the warfarin INR is:
  5. Question 5
    Easy
    The teaching point is that in most anticoagulated patients, the safest plan for a simple extraction is:

Reset this case?

This clears your answers for this patient case only.

Patient case: ACE inhibitor angioedema in a dental patient
0 of 5 answered, 0 correct
Patient
Female, 60 years old
Chief Complaint
Sudden tongue and lip swelling without urticaria, in a patient on lisinopril for hypertension.
Background and/or Patient History
  • Long-standing hypertension on lisinopril
  • Sudden lip and tongue swelling at home and on arrival
  • Difficulty managing secretions; mild stridor on examination
Allergies
NKDA reported
Medications
  • Lisinopril
Current Findings
  • Tongue and lip swelling without urticaria
  • Suspicion of ACE inhibitor angioedema
  1. Question 1
    Moderate
    ACE inhibitor angioedema is mediated by:
  2. Question 2
    Moderate
    Immediate dental management is to:
  3. Question 3
    Hard
    ACE inhibitor angioedema is treated less effectively by:
  4. Question 4
    Hard
    After this episode, the patient should:
  5. Question 5
    Easy
    The dental team should document:

Reset this case?

This clears your answers for this patient case only.

Patient case: Phenytoin, cyclosporine, and a calcium channel blocker
0 of 5 answered, 0 correct
Patient
Male, 55 years old
Chief Complaint
Progressive gingival overgrowth limiting tooth visibility; on phenytoin, cyclosporine, and nifedipine after a kidney transplant.
Background and/or Patient History
  • Kidney transplant, seizures, and hypertension
  • Polypharmacy with all three classic 'enlargement' drugs
  • Significant fibrotic gingival overgrowth
Allergies
NKDA
Medications
  • Phenytoin
  • Cyclosporine
  • Nifedipine
Current Findings
  • Gingival enlargement consistent with the classic triad
  • Plaque control and medication review needed
  1. Question 1
    Easy
    The three drug classes that cause the classic gingival enlargement triad are:
  2. Question 2
    Moderate
    The first-line management is:
  3. Question 3
    Hard
    Possible medication substitutions to discuss with the physician include:
  4. Question 4
    Moderate
    For residual fibrotic overgrowth that does not respond to medical and hygiene measures, the next step is:
  5. Question 5
    Easy
    The teaching point is that gingival enlargement in this patient reflects:

Reset this case?

This clears your answers for this patient case only.

Patient case: Chronic corticosteroids and the stress-dose question
0 of 5 answered, 0 correct
Patient
Female, 64 years old
Chief Complaint
Routine restorative work scheduled; takes prednisone 7.5 mg daily for rheumatoid arthritis for 5 years.
Background and/or Patient History
  • Rheumatoid arthritis on long-term prednisone 7.5 mg daily
  • Otherwise stable; routine restorative work scheduled
  • Family asks if a 'stress dose' of steroid is needed
Allergies
NKDA
Medications
  • Prednisone 7.5 mg daily
  • Methotrexate weekly
Current Findings
  • Long-term prednisone with likely HPA suppression
  • Routine outpatient dental procedure
  1. Question 1
    Moderate
    Long-term oral corticosteroids (more than approximately 5 mg prednisone/day for more than approximately 3 weeks) can suppress:
  2. Question 2
    Hard
    For ROUTINE outpatient dental work in this patient, the recommendation is to:
  3. Question 3
    Moderate
    Stress-dose steroids may be warranted for:
  4. Question 4
    Hard
    Adrenal crisis presents with:
  5. Question 5
    Easy
    The teaching point is that long-term steroid use requires:

Reset this case?

This clears your answers for this patient case only.

Patient case: Bisphosphonates, denosumab, and MRONJ prevention
0 of 5 answered, 0 correct
Patient
Female, 68 years old
Chief Complaint
About to start an intravenous antiresorptive for cancer-related bone disease; has several non-restorable teeth.
Background and/or Patient History
  • Metastatic breast cancer with bone involvement
  • IV zoledronate (or denosumab) about to start
  • Several non-restorable teeth that may need extraction
Allergies
NKDA
Medications
  • Pending IV antiresorptive
Current Findings
  • High MRONJ risk profile with IV cancer-dose antiresorptive
  • Pre-therapy dental optimization opportunity
  1. Question 1
    Moderate
    MRONJ risk is:
  2. Question 2
    Moderate
    The most effective MRONJ prevention is to:
  3. Question 3
    Moderate
    If a tooth must be extracted in a patient ALREADY on therapy, the approach is:
  4. Question 4
    Hard
    Denosumab differs from bisphosphonates in that it:
  5. Question 5
    Easy
    The teaching point is that antiresorptive therapy:

Reset this case?

This clears your answers for this patient case only.

Patient case: Chairside hypoglycemia from diabetes medications
0 of 5 answered, 0 correct
Patient
Male, 58 years old
Chief Complaint
Diaphoresis, tremor, and confusion midway through a long restorative appointment; on glipizide and insulin.
Background and/or Patient History
  • Type 2 diabetes on glipizide (a sulfonylurea) and basal insulin
  • Skipped breakfast on the way to a long restorative appointment
  • Symptoms developed midway through the procedure
Allergies
NKDA
Medications
  • Glipizide
  • Insulin glargine
  • Empagliflozin
Current Findings
  • Diaphoresis, tremor, confusion in a fasted diabetic on insulin and a sulfonylurea
  • High suspicion for hypoglycemia
  1. Question 1
    Easy
    The most likely cause of the symptoms is:
  2. Question 2
    Easy
    Immediate management for the conscious, swallowing patient is:
  3. Question 3
    Moderate
    For the OBTUNDED hypoglycemic patient who cannot swallow safely, the next step is:
  4. Question 4
    Hard
    Empagliflozin in this patient carries the peri-procedural caution of:
  5. Question 5
    Easy
    The teaching point is that diabetic patients require:

Reset this case?

This clears your answers for this patient case only.

Patient case: Chemotherapy mucositis and cytopenia before dental work
0 of 5 answered, 0 correct
Patient
Male, 50 years old
Chief Complaint
Painful oral ulcerations one week after the most recent chemotherapy cycle; needs a non-emergent restoration.
Background and/or Patient History
  • Receiving 5-FU-based chemotherapy for colorectal cancer
  • Severe oral mucositis with painful ulcerations and oral intake difficulty
  • Otherwise stable; restorative appointment requested
Allergies
NKDA
Medications
  • 5-FU-based chemotherapy
Current Findings
  • Severe oral mucositis (5-FU is a notorious cause)
  • Cytopenic nadir likely; elective dentistry concern
  1. Question 1
    Moderate
    Oral mucositis in this patient is most likely caused by:
  2. Question 2
    Moderate
    Before invasive dental procedures, the dentist should check:
  3. Question 3
    Moderate
    Symptomatic management of severe mucositis includes:
  4. Question 4
    Moderate
    Elective dental procedures in this patient should:
  5. Question 5
    Easy
    The teaching point is that chemotherapy:

Reset this case?

This clears your answers for this patient case only.

Patient case: SSRIs, bleeding tendency, and bruxism
0 of 5 answered, 0 correct
Patient
Female, 45 years old
Chief Complaint
Reports easy bruising and gum bleeding; takes an SSRI for depression and has worsening bruxism.
Background and/or Patient History
  • Major depressive disorder on sertraline (SSRI) for several years
  • New complaint of easy bruising and gum bleeding with hygiene
  • Worsening bruxism noted
Allergies
NKDA
Medications
  • Sertraline (SSRI)
Current Findings
  • Mild platelet dysfunction associated with SSRIs
  • Bruxism associated with SSRIs
  1. Question 1
    Hard
    SSRIs (selective serotonin reuptake inhibitors) can raise dental and surgical bleeding because they:
  2. Question 2
    Moderate
    Bruxism is associated with:
  3. Question 3
    Moderate
    For dental analgesia in a patient on an SSRI, the safer choice is:
  4. Question 4
    Moderate
    Management of bruxism in this patient includes:
  5. Question 5
    Easy
    The teaching point is that an SSRI in the medical history changes:

Reset this case?

This clears your answers for this patient case only.

Patient case: The medication review as the high-yield intervention
0 of 5 answered, 0 correct
Patient
Female, 72 years old
Chief Complaint
Routine recall; brings in a long medication list including all of the high-yield classes above.
Background and/or Patient History
  • Atrial fibrillation on apixaban
  • Hypertension on metoprolol and amlodipine
  • Type 2 diabetes on metformin and empagliflozin
  • Osteoporosis on weekly oral alendronate
  • Reflux on omeprazole; SSRI for depression
Allergies
NKDA
Medications
  • Apixaban
  • Metoprolol
  • Amlodipine
  • Metformin
  • Empagliflozin
  • Alendronate (oral)
  • Omeprazole
  • Sertraline
Current Findings
  • Real-world polypharmacy elderly patient
  • Composite case across the chapter
  1. Question 1
    Moderate
    For routine cleaning and a simple extraction, apixaban should be:
  2. Question 2
    Hard
    Metoprolol changes the dental plan because:
  3. Question 3
    Moderate
    Amlodipine in this patient may produce:
  4. Question 4
    Hard
    Empagliflozin and alendronate in this patient raise the peri-procedural questions of:
  5. Question 5
    Easy
    The teaching point of this composite case is that:

Reset this case?

This clears your answers for this patient case only.

Keep studying
Drugs the Dentist Meets in Medical History core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

← Back to Drugs the Dentist Meets in Medical History