A child undergoing chemotherapy for acute lymphoblastic leukaemia has a furcation radiolucency on a primary second molar. What is the appropriate treatment?

Correct answer: A. Extraction

• A. CORRECT. In an IMMUNOCOMPROMISED, myelosuppressed child, any focus of odontogenic infection is a potential source of life-threatening septicaemia. A furcation radiolucency means the pulp is necrotic and the infection has already spread. Pulp therapy leaves infected tissue behind and cannot be relied upon. The tooth must be EXTRACTED — ideally before chemotherapy begins, or during a period of adequate neutrophil and platelet counts.
• B. Pulpectomy of a primary molar cannot predictably eliminate infection from the complex accessory canal network of the furcation — an unacceptable risk in a neutropenic patient.
• C. Observation of an active infection in an immunosuppressed child is dangerous and inappropriate.
• D. Pulpotomy is contraindicated: it presupposes a vital, uninflamed radicular pulp, and a furcation lucency proves otherwise.

Note: Coordinate with the oncologist. Elective dental care is generally deferred until the absolute neutrophil count exceeds roughly 1,000/mm³ and platelets exceed 50,000/mm³; urgent infection is managed regardless, with haematological support.