Pregnant patient, third trimester — painful #19

Correct answer: C. Pulpectomy (complete removal of the pulp / initiate root canal treatment)

• A. Waiting until delivery leaves the patient in pain and risks progression to an acute apical abscess — untreated infection poses more risk to mother and fetus than the treatment does.
• B. Antibiotics have no role in irreversible pulpitis without systemic involvement; the pulp must be removed.
• C. Correct. A symptomatic irreversible pulpitis is an EMERGENCY and pain relief is not deferred for pregnancy. Definitive pulp removal (pulpectomy / RCT) is the treatment that eliminates the pain source. Treatment in the third trimester is permissible with short appointments, left-lateral positioning to avoid supine hypotensive syndrome, and appropriate shielding for radiographs.
• D. A pulpotomy leaves inflamed radicular pulp behind in a mature permanent tooth with irreversible pulpitis; it is at best a temporising measure and would not reliably resolve the pain.

Note: Second trimester remains the IDEAL elective window, but urgent care is provided whenever it is needed, including the third trimester.

Correct answer: D. Symptomatic apical periodontitis

• A. A chronic apical abscess is characterised by INTERMITTENT DRAINAGE through a sinus tract and is typically asymptomatic; no tract is described.
• B. An acute apical abscess presents with rapid onset, swelling, and often systemic signs — the case explicitly states no abscess.
• C. Asymptomatic apical periodontitis is a radiographic apical radiolucency with NO percussion tenderness or pain; this patient is percussion-positive.
• D. Correct. TENDERNESS TO PERCUSSION indicates inflammation extending into the periodontal ligament — symptomatic apical periodontitis. It may exist with or without a radiographic periapical radiolucency.