Methotrexate – A Potential Risk Factor for Delayed Healing and Medication-Related Osteonecrosis of the Jaw Following Dental Extractions – A Case Study Aiming to Raise Awareness in Clinical Practice

Abstract

A case report documenting how a routine atraumatic extraction of a lower right second premolar in a female patient with rheumatoid arthritis taking methotrexate, hydroxychloroquine, certolizumab pegol and pain relief medication, resulted in the sequestration of bone in the coronal aspect of the socket, inflammation, suppuration, and delayed healing mimicking medication-related osteonecrosis of the jaw. Treatment of the lesion involved a methotrexate drug holiday (after consulting with her rheumatologist), antibiotics, chlorhexidine and saltwater rinses as well as surgical curettage of the lesion under local anaesthesia. This case report highlights to the general dental practitioner an important potential link between methotrexate and medication-related osteonecrosis of the jaw and is strengthened by case studies from the literature. An emphasis on liaising with other health care professionals such as the rheumatologist is also made.