Endodontics · patient case question
What is the pulpal diagnosis?
Patient case: Pregnant patient with lingering pain
Patient: Female, 29 years old
Chief Complaint: Severe pain in a lower molar, worse with hot, relieved briefly by cold.
Background: 24 weeks pregnant, uncomplicated pregnancy. No other medical history.
Current Findings: Deep caries in tooth #19. Pain lingers for several minutes after a cold stimulus is removed and wakes her at night. The tooth is tender to percussion. No swelling and no sinus tract.
Show answer and explanation
Correct answer: C. Symptomatic irreversible pulpitis
- A. A chronic apical abscess is characterised by a draining sinus tract and is typically asymptomatic or only mildly uncomfortable — the opposite of this presentation.
- B. In reversible pulpitis the pain is sharp but resolves within seconds of removing the stimulus, and there is no spontaneous or nocturnal pain. Removing the irritant lets the pulp recover.
- C. CORRECT. Pain that LINGERS after the stimulus is removed, is spontaneous, wakes the patient at night, and is relieved by cold in a hot-sensitive tooth is the classic picture of symptomatic irreversible pulpitis. The pulp cannot recover and must be removed.
- D. A necrotic pulp does not respond to thermal testing at all. This pulp is responding vigorously.
Note: Full diagnosis for this tooth: symptomatic irreversible pulpitis WITH symptomatic apical periodontitis. INBDE expects both a pulpal and a periapical diagnosis for every endodontic case.