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Endodontics · single question

DAY 2 — CASE 20: A patient presents with LINGERING PAIN and a POSITIVE PERCUSSION test. What are the correct pulpal and periapical diagnoses?

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

  • A. Reversible pulpitis would show BRIEF pain that resolves quickly with stimulus removal — not lingering. Normal apical tissues = no percussion tenderness.
  • B. Pulp necrosis would not cause lingering pain because there is no vital pulp to generate pain signals — the tooth would be non-responsive to vitality tests.
  • C. LINGERING PAIN (pain that persists after stimulus removal) = SYMPTOMATIC IRREVERSIBLE PULPITIS. The pulp is inflamed beyond recovery and produces spontaneous or prolonged pain. POSITIVE PERCUSSION (pain on tapping) = SYMPTOMATIC APICAL PERIODONTITIS (SAP). Inflammation has extended to the periapical tissues via the apical foramen. Therefore: Symptomatic irreversible pulpitis + Symptomatic apical periodontitis.
  • D. ASYMPTOMATIC irreversible pulpitis: No spontaneous pain — contradicts the 'lingering pain' finding.

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