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Endodontics · single question

A 16-year-old female has pain on upper right first premolar that awakens her at night. Cold test produces lingering pain >12 seconds. Tooth is tender to percussion. What is the diagnosis?

  1. Reversible pulpitis with asymptomatic apical periodontitis
  2. Normal pulp with symptomatic apical periodontitis
  3. Irreversible pulpitis with symptomatic apical periodontitis
  4. Irreversible pulpitis with acute apical abscess
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Correct answer: A. Reversible pulpitis with asymptomatic apical periodontitis

  • A. Correct. Spontaneous/nocturnal pain + lingering cold response >12 seconds = Irreversible Pulpitis. Tenderness to percussion (TTP) = Symptomatic Apical Periodontitis. Classic IRP + SAP combination.
  • B. Incorrect. Reversible pulpitis has a brief sharp cold response that disappears quickly. Nocturnal pain + lingering cold = irreversible.
  • C. Incorrect. Acute apical abscess would show swelling, purulent drainage, and severe spontaneous pain.
  • D. Incorrect. Normal pulp responds briefly to cold and is not tender to percussion.

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