Endodontics · single question
A pregnant patient in her 3rd trimester has severe, lingering pain on tooth 29 that responds to cold testing and is tender on percussion. What is the proper treatment?
Show answer and explanation
Correct answer: A. Start pulpectomy
Severe, lingering cold response + percussion tenderness = SYMPTOMATIC IRREVERSIBLE PULPITIS. Dental treatment can and should be provided during any trimester when necessary. The 2nd trimester is preferred for elective care, but acute pain and infection are emergencies that require treatment REGARDLESS of trimester. Starting a pulpectomy (opening the pulp, extirpating tissue, cleaning and shaping, placing a temporary) relieves pain and prevents infection. Deferring treatment risks abscess formation during pregnancy. Antibiotics alone do not address the pulpal pathology.
- A. CORRECT. Emergency endodontic treatment (pulpectomy) is appropriate and necessary in the 3rd trimester for symptomatic irreversible pulpitis. Local anesthesia (lidocaine 1:100k epi) is safe. The procedure relieves pain and prevents progression to abscess. The 3rd trimester is not a contraindication to endodontic emergency treatment.
- B. INCORRECT. Antibiotics alone do not treat irreversible pulpitis — the source of pain (inflamed pulp) must be mechanically addressed. Antibiotics are adjuncts when systemic infection is present.
- C. INCORRECT. Extraction would also be acceptable as an emergency measure, but it is more traumatic and pulpectomy is preferable to preserve the tooth in a pregnant patient.
- D. INCORRECT. Deferring treatment risks the condition progressing to an abscess, which is far more dangerous to the pregnancy than appropriate dental treatment. Untreated infection during pregnancy poses significant risks.