Medical Emergencies · patient case question
When should definitive treatment be carried out?
Patient case: Pregnant patient with lingering pain
Patient: Female, 29 years old
Chief Complaint: Severe pain in a lower molar, worse with hot, relieved briefly by cold.
Background: 24 weeks pregnant, uncomplicated pregnancy. No other medical history.
Current Findings: Deep caries in tooth #19. Pain lingers for several minutes after a cold stimulus is removed and wakes her at night. The tooth is tender to percussion. No swelling and no sinus tract.
Show answer and explanation
Correct answer: A. Immediately — pulpectomy or root canal treatment should not be deferred
- A. CORRECT. Pulpectomy is performed IMMEDIATELY. Untreated infection and uncontrolled pain are themselves risks in pregnancy — pain generates maternal stress and catecholamine release, and untreated dental infection is associated with adverse pregnancy outcomes. The second trimester is the most comfortable operative window, and this patient is in it, but urgency overrides timing in any trimester.
- B. Waiting for swelling means waiting for the infection to spread. That is precisely what treatment is meant to prevent.
- C. Deferring until delivery leaves months of pain and an infected pulp. Analgesic management of irreversible pulpitis is not treatment.
- D. The third trimester brings supine hypotensive syndrome and simple physical discomfort in the chair. It is the LESS favourable window, not the more favourable one.
Note: Radiographs when clinically indicated are safe throughout pregnancy with a lead apron and thyroid collar — the fetal dose from a dental film is negligible. Position the patient slightly on her LEFT side in the later stages to keep the gravid uterus off the inferior vena cava.
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