Endodontics · patient case question
What is the diagnosis for tooth #2?
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: B. Pulp necrosis with symptomatic apical periodontitis
- A. There is no history or radiographic evidence of previous endodontic treatment.
- B. Correct. No response to cold indicates necrosis; pain on percussion and palpation with a periapical radiolucency indicates symptomatic apical periodontitis.
- C. Irreversible pulpitis requires a vital, responsive pulp — this pulp does not respond.
- D. Reversible pulpitis cannot coexist with a non-responsive pulp and apical breakdown.