For the same 5-year-old patient with a fistula (parulis) associated with tooth F, what is the MOST appropriate treatment?

Correct answer: D. Extraction of tooth F to eliminate the source of infection

• A. Antibiotics manage the acute phase of infection but do not eliminate the source (the infected primary tooth). Observation without definitive treatment allows ongoing infection and bone damage.
• B. Pulpotomy is appropriate for vital, cariously exposed primary teeth without periapical pathology. A draining sinus tract indicates irreversible pulp and/or periapical disease — pulpotomy is contraindicated.
• C. A crown without pulp treatment on a tooth with periapical infection would seal in the infection and worsen the situation — never appropriate when periapical disease is present.
• D. CORRECT. A parulis/fistula associated with a primary tooth indicates a chronic, non-vital periapical infection. In primary molars with furcation involvement or a draining sinus tract, the prognosis for pulpotomy is poor — the tooth is typically non-restorable by pulp therapy. EXTRACTION is the treatment of choice to eliminate the chronic infection and allow normal eruption of the permanent successor.