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Endodontics · patient case with 3 questions

Endodontic Emergency in Pregnancy

demo: 29-year-old female, 32 weeks pregnant

chief: “The lower left tooth has been keeping me awake for three nights.”

history: Uncomplicated pregnancy, third trimester. Obstetrician cleared for necessary dental care.

meds: Prenatal vitamins

findings: Tooth #19 with a deep distal carious lesion, lingering pain to cold, tender to percussion. Vital pulp on access.

Question 1

What is the most appropriate treatment for tooth #19?

  1. Pulpotomy to relieve the acute symptoms
  2. Prescription of an opioid analgesic and reassessment after delivery
  3. Sedative temporary restoration and observation
  4. Extraction under local anesthesia
Show answer and explanation

Correct answer: A. Pulpotomy to relieve the acute symptoms

  • A. Correct. Removing the inflamed coronal pulp relieves the pain immediately, is a short appointment well tolerated in the third trimester, and allows definitive treatment later.
  • B. Leaving an acutely inflamed pulp untreated with opioids risks progression to abscess and exposes the fetus to unnecessary medication.
  • C. A sedative dressing will not control pain from irreversible pulpitis.
  • D. Extraction sacrifices a restorable tooth and is more invasive than needed.

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Question 2

When should this treatment be performed?

  1. Immediately — acute infection and uncontrolled pain pose more risk than treatment
  2. After 40 weeks, once the patient has delivered
  3. Only during the second trimester window, which has passed
  4. After a 10-day course of antibiotics
Show answer and explanation

Correct answer: A. Immediately — acute infection and uncontrolled pain pose more risk than treatment

  • A. Correct. The second trimester is the preferred window for elective care, but genuine emergencies are treated whenever they occur. Untreated infection and pain carry real maternal and fetal risk.
  • B. Waiting weeks with an acutely inflamed pulp invites spreading infection.
  • C. The second trimester preference applies to elective procedures, not emergencies.
  • D. Antibiotics do not address the source; the inflamed pulp must be removed.

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Question 3

Articaine carries which FDA pregnancy category?

  1. Category C
  2. Category A
  3. Category B
  4. Category X
Show answer and explanation

Correct answer: A. Category C

  • A. Correct. Articaine is Category C, meaning animal studies show adverse effects or data are lacking. Lidocaine and prilocaine are Category B and are conventionally preferred in pregnancy.
  • B. No local anesthetic used in dentistry carries Category A.
  • C. Category B applies to lidocaine, prilocaine, and etidocaine — not articaine.
  • D. Category X is reserved for agents with proven fetal risk that outweighs any benefit, such as isotretinoin.

Note: The FDA replaced the letter categories with the Pregnancy and Lactation Labeling Rule in 2015, but board recalls still use the old system.

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