Endodontics · patient case question
The restorations were technically sound. Why does the patient perceive sensitivity in #28?
Patient case: Post-restorative sensitivity in the mandibular right posterior sextant
Patient: Adult periodontal maintenance patient
Chief complaint: Sensitivity after restorations were placed in teeth #28 and #29.
Background: Controlled periodontal patient. The restorations were well executed.
Current findings: Gingival recession of 3 mm and bone loss. Radiographs of the region are provided.
Show answer and explanation
Correct answer: C. Referred pain from #29
- A. Nothing in the history indicates necrosis of #28.
- B. Occlusal trauma produces pain on percussion and biting, mediated by the periodontal ligament — which, unlike the pulp, DOES localise well.
- C. CORRECT. Pulpal pain is notoriously poorly localised, because the pulp contains no proprioceptors. Pain is readily REFERRED between adjacent teeth within the same quadrant and across the same nerve distribution. The symptomatic tooth is #29; #28 merely receives the referral. This is exactly why pulp testing of multiple teeth, not just the one the patient points at, is essential.
- D. A cracked cusp gives sharp pain on release of biting pressure, not this presentation.
Note: Referred pain does not cross the midline, and mandibular posterior teeth commonly refer to the opposing arch on the same side.