A patient presents with a chronic parulis (gum boil) with a photograph and periapical radiograph showing a periapical radiolucency. What is the pulpal diagnosis?

Correct answer: D. Pulp necrosis

• A. Asymptomatic irreversible pulpitis has irreversibly damaged pulp without spontaneous pain; a parulis with periapical radiolucency indicates the infection has spread beyond the pulp — necrosis.
• B. Reversible pulpitis is a mild inflammation; it does not cause periapical pathology or a parulis.
• C. Symptomatic irreversible pulpitis causes lingering pain to thermal stimuli; a chronic draining parulis indicates the pulp is no longer responding to stimuli (necrotic).
• D. Correct. A chronic parulis (draining sinus tract/fistula) with a periapical radiolucency represents pulp necrosis with a chronic periapical abscess/granuloma. The drainage through the sinus tract explains why symptoms are minimal.