Endodontics · patient case with 1 question
16-year-old with lingering pain and percussion tenderness
Scenario: A 16-year-old female with pain on the upper right first premolar. The pain AWAKENS HER AT NIGHT. On cold testing there is LINGERING PAIN FOR MORE THAN 12 SECONDS and there is TENDERNESS TO PERCUSSION.
Question 1
What is the diagnosis?
Show answer and explanation
Correct answer: D. Symptomatic irreversible pulpitis with symptomatic apical periodontitis
- A. Pulp necrosis is excluded because the tooth still responds to cold. An acute apical abscess would also involve swelling and rapid onset.
- B. Reversible pulpitis is excluded by the lingering and spontaneous nocturnal pain.
- C. Normal apical tissues would mean the tooth is NOT tender to percussion — but it is.
- D. Correct. Endodontic diagnosis always requires BOTH a pulpal AND a periapical component. Spontaneous, nocturnal, lingering pain to cold gives the PULPAL diagnosis of symptomatic irreversible pulpitis; the additional TENDERNESS TO PERCUSSION shows that inflammation has extended into the periodontal ligament, giving the PERIAPICAL diagnosis of symptomatic apical periodontitis.
Note: Compare directly with the preceding case: the ONLY difference is percussion tenderness, and that single finding changes the periapical half of the diagnosis. Always test and report both components.