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Endodontics · single question

A 16-year-old has spontaneous nocturnal pain on tooth #5, lingering cold response >12 seconds, and percussion sensitivity. What is the COMBINED pulpal/periapical diagnosis?

  1. Asymptomatic irreversible pulpitis with normal apical tissues
  2. Symptomatic irreversible pulpitis with symptomatic apical periodontitis
  3. Reversible pulpitis with normal apical tissues
  4. Pulp necrosis with symptomatic apical periodontitis
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Correct answer: B. Symptomatic irreversible pulpitis with symptomatic apical periodontitis

Spontaneous pain + lingering cold >10 sec = symptomatic irreversible pulpitis. Percussion sensitivity = symptomatic apical periodontitis.
  • A. Asymptomatic irreversible pulpitis has no spontaneous symptoms — found incidentally. This patient has significant spontaneous pain.
  • B. CORRECT. Symptomatic irreversible pulpitis: spontaneous pain, lingering cold >10 seconds. Symptomatic apical periodontitis: percussion sensitivity indicating periapical inflammation. Combined diagnosis = SIP + SAP.
  • C. Reversible pulpitis has a brief cold response that resolves quickly — no lingering. Rules this out.
  • D. Pulp necrosis = NO cold response. This patient has a positive (lingering) cold response — pulp is still vital.

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