A 32-week pregnant patient presents with severe tooth pain on tooth #19 (lower left first molar). The tooth responds to cold with lingering pain that persists for 30 seconds after the stimulus is removed. No periapical radiolucency is visible. What treatment should be performed?

Correct answer: D. Pulpotomy (if symptoms are limited to the coronal pulp) or full root canal treatment, with appropriate positioning modifications for the 3rd trimester

• A. Deferral of treatment for a patient in acute pulpal pain risks abscess formation, bacteremia, and systemic infection — all more dangerous to the pregnancy than properly managed dental treatment.
• B. Extraction would not preserve the tooth and is more traumatic than RCT. Extraction is appropriate only if the tooth is non-restorable. The question implies the tooth may be saved with endodontic treatment.
• C. Antibiotics do not treat irreversible pulpitis — the source of pain is inflammatory, not primarily infectious at this stage. Pain persists until pulp is removed.
• D. CORRECT. The presentation (cold lingering >10-15 sec, no periapical pathology) is consistent with symptomatic irreversible pulpitis. Treatment is necessary regardless of trimester when the patient is in pain. For a 3rd trimester patient: use semi-reclined position (left lateral tilt) to avoid aortocaval compression; use lidocaine with epinephrine; perform RCT or at minimum emergency pulpotomy for pain relief. Deferral of necessary treatment is inappropriate.