Pediatric Dentistry · patient case question
What is the pulpal diagnosis?
Patient case: Discoloured primary incisors after an old injury
Patient: Female, 4 years old, accompanied by her father
Chief complaint: Father: “Her two front teeth have gone dark and now she says they hurt.”
History: Fell against a coffee table about a year ago. Teeth E and F were bruised but not displaced and were not treated at the time.
Findings: Teeth E and F are grey-brown. Both are tender to percussion. Neither responds to pulp testing. A sinus tract is present buccal to tooth E. Radiographs show periapical radiolucencies on both, with roots not yet resorbing.
Show answer and explanation
Correct answer: C. Pulp necrosis
- A. Reversible pulpitis is a vital pulp responding briefly to stimulus with no periapical change. There is no vitality here and there are periapical lesions.
- B. Internal resorption would show as an oval radiolucent expansion of the canal itself, and requires vital inflamed pulp tissue to drive it. Periapical lucencies with a non-vital tooth are a different process.
- C. CORRECT. Three findings converge on NECROSIS: no response to pulp testing, tenderness to percussion with periapical radiolucencies indicating that inflammation has passed beyond the apex, and a sinus tract confirming an established chronic infection with a drainage pathway. Crown discolouration completes the picture. The trauma a year ago severed the apical neurovascular supply, and the pulp died slowly and silently.
- D. Symptomatic irreversible pulpitis requires a VITAL pulp giving lingering pain. A non-responsive tooth with periapical radiolucency has moved past that stage.
Note: Pulp testing in a four-year-old is unreliable — cold and electric testing give inconsistent results in primary teeth. Weight the objective findings: sinus tract, percussion tenderness and radiographic lucency.
Practice Pediatric Dentistry questions Pediatric Dentistry study notes