Endodontics · patient case question
Regarding the fractured lingual cusp of tooth #29, what should be evaluated first?
Patient case: The Pimple That Comes and Goes
Patient: 52-year-old female
Chief Complaint: “There’s a pimple on my gum that comes and goes. It’s been almost two years.”
Background: Healthy, no medications. Describes intermittent swelling that drains, subsides for weeks, then recurs. Minimal pain throughout.
Medications: None
Vital Signs: BP 124/78 mmHg · HR 72 bpm · RR 16 · T 98.4°F
Findings: Tooth #14 has no restoration and has never received endodontic treatment. It gives no response to cold and is not tender to percussion. A well-defined periapical radiolucency is present, and a gutta-percha point placed in the sinus tract tracks radiographically to the apex of #14. Separately, tooth #29 has a fractured lingual cusp. Tooth #17 is horizontally impacted and its crown contacts the distal root of #18, which shows a concave radiolucent defect at the point of contact.
Show answer and explanation
Correct answer: D. Pulp vitality status
- A. Incorrect. The opposing tooth is relevant to occlusal assessment but is not the first evaluation on a fractured cusp.
- B. Incorrect. Shade selection is a restorative detail addressed after the tooth is confirmed treatable and the material chosen.
- C. Incorrect. Percussion is one component of a full examination but tells you only about the periapical tissues. On its own it does not establish the pulpal status that drives the treatment decision.
- D. Correct. Whether the pulp is vital, inflamed, or necrotic determines the entire treatment pathway — whether the tooth can simply be restored or requires endodontic treatment first. Cold testing with a comparison to a control tooth is the appropriate starting point, alongside assessment of how far subgingivally the fracture extends.
Note: Both are defensible and in practice they are assessed together: pulpal status determines whether endodontic treatment is needed, and the subgingival extent of the fracture determines whether the tooth is restorable at all. If a question offers both, read carefully for whether it emphasizes symptoms or structural loss.