Oral Surgery · patient case question
What is the most appropriate treatment for tooth #15?
Patient case: Elderly man with Alzheimer disease and a symptomatic upper left molar
Patient: Male, 78 years old
Chief complaint: “His tooth has been hurting him and his face is swollen.” Reported by the wife, who accompanies him.
Background: Alzheimer disease, moderate stage. Medication: donepezil. His wife attends every appointment and manages his daily care.
Current findings: Periapical radiograph shows tooth #15 lying on its side (slanted/impacted) with an associated radiolucency. Swelling and pain localised to #15. Patient is pleasantly confused and defers all questions to his wife.
Show answer and explanation
Correct answer: C. Extraction
- A. Pulpectomy of a horizontally impacted molar is not realistically achievable, and would commit a demented patient to multiple long visits.
- B. Pulpotomy is a procedure for vital primary teeth or as an interim measure in immature permanent teeth — not applicable.
- C. CORRECT. The tooth is impacted, lying on its side, symptomatic and associated with a radiolucency. It is not restorable or functionally useful. In a patient with moderate dementia and limited tolerance for lengthy or repeated appointments, definitive removal of the source of infection is the appropriate, humane and lowest-burden option.
- D. Observation leaves an active infection in place, which is unacceptable given the pain and swelling.