Endodontics · patient case question
What is the pulpal diagnosis for tooth #19?
Patient case: Generalized Caries and a Throbbing Lower Left
Patient: 41-year-old male
Chief Complaint: “The bottom left throbs for twenty minutes every time I drink anything cold.”
Background: No dental care in 6 years. Drinks four sweetened sodas daily. Healthy, no medications, no allergies. Smokes occasionally at social events only.
Medications: None
Vital Signs: BP 122/78 mmHg · HR 74 bpm · RR 16 · T 98.4°F
Findings: Generalized caries. Tooth #19: deep distal caries, exaggerated and lingering response to cold lasting 20 seconds, no percussion tenderness, no periapical radiolucency. Tooth #18: subgingival distal caries with a narrow vertical bony defect on the distal; would require both crown lengthening and root canal treatment to restore. A full mouth radiographic series shows dark bands running across the premolar film.
Show answer and explanation
Correct answer: A. Symptomatic irreversible pulpitis
- A. Correct. Pain that lingers well beyond removal of the cold stimulus is the defining feature. The inflammation has progressed beyond the capacity of the pulp to recover, and root canal treatment or extraction is required.
- B. Incorrect. Symptomatic apical periodontitis is a periapical diagnosis characterized by tenderness to percussion and biting. This tooth is not percussion tender.
- C. Incorrect. In reversible pulpitis the response is sharp but resolves within a second or two of stimulus removal. Removing the irritant allows the pulp to heal.
- D. Incorrect. A necrotic pulp gives no response to thermal testing at all. This tooth responds vigorously, which confirms vital tissue remains.
Note: Every endodontic case carries two diagnoses — one pulpal and one periapical. Here the pair is symptomatic irreversible pulpitis with normal apical tissues.