Endodontics · patient case question
What is the pulpal and periapical diagnosis for tooth #3?
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: C. Symptomatic irreversible pulpitis
- A. The pulpal response is clearly abnormal, so the pulp is not normal.
- B. A necrotic pulp gives no response to cold at all.
- C. Correct. A thermal response that lingers beyond about 10–20 seconds signals inflammation that will not resolve — symptomatic irreversible pulpitis. Root canal therapy or extraction is indicated.
- D. Reversible pulpitis produces a sharp response that disappears as soon as the stimulus is removed.