Endodontics · patient case question
What is the diagnosis?
Patient case: 25-year-old with lingering pain that wakes him at night
Scenario: A 25-year-old male with pain on the upper right central incisor. The pain AWAKENS HIM AT NIGHT. On cold testing there is LINGERING PAIN FOR MORE THAN 12 SECONDS.
Show answer and explanation
Correct answer: B. Symptomatic irreversible pulpitis
- A. Reversible pulpitis produces a SHARP pain that resolves within a few seconds of stimulus removal, and importantly it does NOT cause spontaneous or nocturnal pain.
- B. Correct. SPONTANEOUS pain that WAKES the patient at night, plus LINGERING pain to cold, is the textbook definition of symptomatic irreversible pulpitis. The pulp is vital but the inflammation has progressed beyond the point of recovery — treatment is pulpectomy/root canal therapy or extraction.
- C. The asymptomatic form is by definition without symptoms; this patient is woken at night.
- D. A necrotic pulp gives NO response to cold at all.
Note: The three cardinal features separating irreversible from reversible pulpitis: SPONTANEOUS pain, pain that LINGERS after stimulus removal, and pain that WAKES the patient at night. Postural pain on lying down is another classic feature.