Endodontics · patient case question
Tooth #5 has pain on biting, percussion tenderness, and apical radiolucency. The periapical diagnosis is:
Patient case: Full-Mouth Pulpal Diagnosis
demo: 46-year-old female
chief: “Several of my teeth on the upper right have been bothering me in different ways.”
history: Non-contributory. No medications.
meds: None
findings: Tooth #2: no response to cold, painful to percussion and palpation, periapical radiolucency. Tooth #3: sharp pain to cold that lingers more than 20 seconds. Tooth #4: exaggerated but non-lingering response to cold, deep restoration. Tooth #5: pain on biting, tender to percussion, widened PDL at the apex.
Show answer and explanation
Correct answer: A. Symptomatic apical periodontitis
- A. Correct. Pain to biting and percussion with apical radiographic change and no swelling or drainage defines symptomatic apical periodontitis.
- B. An acute apical abscess adds rapid onset, swelling, and often systemic signs such as fever and malaise.
- C. Condensing osteitis is a radiopaque, not radiolucent, response to low-grade pulpal irritation.
- D. A chronic apical abscess is characteristically asymptomatic and drains through a sinus tract.