Endodontics · patient case question
What do you do?
Patient case: Pregnant patient, third trimester — painful #19
Scenario: A pregnant patient in her THIRD TRIMESTER presents with pain on tooth #19. Cold testing produces LINGERING pain, and the tooth is TENDER TO PERCUSSION with a mirror handle.
Show answer and explanation
Correct answer: C. Pulpectomy (complete removal of the pulp / initiate root canal treatment)
- A. Waiting until delivery leaves the patient in pain and risks progression to an acute apical abscess — untreated infection poses more risk to mother and fetus than the treatment does.
- B. Antibiotics have no role in irreversible pulpitis without systemic involvement; the pulp must be removed.
- C. Correct. A symptomatic irreversible pulpitis is an EMERGENCY and pain relief is not deferred for pregnancy. Definitive pulp removal (pulpectomy / RCT) is the treatment that eliminates the pain source. Treatment in the third trimester is permissible with short appointments, left-lateral positioning to avoid supine hypotensive syndrome, and appropriate shielding for radiographs.
- D. A pulpotomy leaves inflamed radicular pulp behind in a mature permanent tooth with irreversible pulpitis; it is at best a temporising measure and would not reliably resolve the pain.
Note: Second trimester remains the IDEAL elective window, but urgent care is provided whenever it is needed, including the third trimester.