From the textbook and abbots L1 Pulp and peridicularconditions D2S1 so metadata can’t be added yet
Diagnosis of Pulp/Canal Status (Quick Reference Table)
| Most likely diagnosis | Pain history (key pattern) | Cold/EPT (sensibility) | Percussion / palpation | Radiograph (typical) | Key discriminator / notes |
|---|---|---|---|---|---|
| Clinically Normal Pulp | No symptoms | Normal response; no lingering | Normal | Normal PDL/lamina dura; no pathosis | May not be histologically normal, but no disease requiring treatment |
| Chronic Reversible Pulpitis | Occasional, long-standing; sharp but mild; short (seconds); only with extreme temp | Responds; no lingering | Usually normal or ± | Usually normal | Distinguish from irreversible: short, needs extreme temp |
| Acute Reversible Pulpitis | Recent onset (hours–days); occurs every time stimulus applied; sharp mild; short (seconds); extreme temp | Responds; no lingering | Usually normal or ± | Usually normal | Distinguish from chronic reversible: recent + consistent symptoms |
| Chronic Irreversible Pulpitis | Long-standing (months); occasional; triggered by minor temp; sharp/severe → dull ache; lingers >5 min | Often exaggerated/lingering | Often + (or may be ± early) | ± (may be normal early) | Core feature: lingering pain with minor temp change |
| Acute Irreversible Pulpitis | Recent onset (days); minor temp triggers; severe; lingers >5 min; may be spontaneous, worse lying down, wakes at night | Often exaggerated/lingering | Often + | ± (may be normal early) | “Spontaneous/night/lying down” supports acute irreversible |
| Pulp Necrobiosis (Partial necrosis) | Mixed symptoms (pulpitis + necrosis); often severe/distressing; may be relieved by iced water swishing | Mixed/inconclusive | Variable | Variable | Brief stage; diagnosis often difficult due to inconsistent tests |
| Pulp Necrosis w/ No Signs of Infection | No thermal symptoms; often trauma history | No response | Normal | Normal PDL/lamina dura | Necrotic but not infected (no coronal bacterial pathway) |
| Necrotic and Infected Pulp | Typically no pulp-type thermal sensitivity; may have periapical discomfort | No response | Often tender to percussion (+) | No radiolucency yet | Distinguish from “necrosis no infection” by periapical symptoms |
| Pulpless & Infected Root Canal System | Periapical symptoms may be present (often dull ache / biting pain) | No response | Often + | Periapical radiolucency present | If radiolucency present with necrotic canal → this diagnosis |
| Previous Endo Tx w/ No Signs of Infection | No symptoms | May or may not respond (depends on procedure) | Normal | No radiolucency | Requires history/radiographic evidence of prior endo procedure |
| Previous Endo Tx w/ Infected RCS | Symptoms (if present) are periapical (biting/percussion, sinus) | Often no meaningful pulp response | Often + | Radiolucency present | Prior endo + radiolucency → treat as infected canal system |