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?

Correct answer: D. Irreversible pulpitis with symptomatic apical periodontitis

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

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