TNF Inhibitor Dental Risk — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementTNF Inhibitor Dental RiskORE Part 1

A patient with rheumatoid arthritis takes methotrexate and adalimumab, a TNF-alpha inhibitor, and requires dental treatment. Which adverse-effect consideration is most relevant to dental care?

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Correct answer: D — Greater susceptibility to oral and dental infection

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · A = shown as D · C = shown as E

A is correct. Adalimumab is a TNF-alpha antagonist; its UK SmPC warns that TNF-antagonists impair host defence and make patients more susceptible to serious infection. Its listed adverse effects include oral infections, such as oral herpes and tooth infections. Therefore, before invasive dental treatment, the clinician should identify and manage active infection promptly and maintain vigilance for infection or impaired recovery, particularly as this patient also takes methotrexate. Gingival enlargement is classically associated with drugs such as phenytoin, ciclosporin and calcium-channel blockers, not adalimumab. Intrinsic tooth staining, xerostomia and enamel erosion are likewise not key recognised dental adverse effects of adalimumab.

Reference: Electronic Medicines Compendium. Humira (adalimumab) 80 mg solution for injection in pre-filled pen: Summary of Product Characteristics, section 4.4, 2026. https://www.medicines.org.uk/emc/product/9678/smpc