A pregnant patient in her third trimester presents with irreversible pulpitis (lingering cold pain and pain on percussion) on tooth #19. What is the most appropriate management?

Root canal treatment (pulpectomy) is safe and appropriate during the second and third trimesters of pregnancy. Irreversible pulpitis is painful and requires definitive treatment; delaying can lead to acute abscess, which is more dangerous to both mother and fetus. The second trimester is ideal for elective procedures, but emergency or necessary treatment should not be withheld in the third trimester. The patient should be positioned with a pillow under the right hip to avoid supine hypotensive syndrome. Local anesthetics with epinephrine are safe in appropriate doses. Pulpotomy alone would not resolve irreversible pulpitis in a permanent molar.