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Reversible Pulpitis — ORE Part 1 MCQ

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ModerateRestorative DentistryReversible PulpitisORE Part 1

A 35-year-old patient has a deep carious lesion in the lower left first molar. The tooth is vital, with occasional mild sensitivity to cold that resolves immediately when the stimulus is removed. It is not tender to percussion, and a periapical radiograph shows normal apical tissues. During excavation, dentine remains over the pulp, but complete caries removal is likely to cause pulp exposure. What is the most appropriate treatment?

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Correct answer: C — Selective caries removal and definitive restoration

This tooth has features of reversible pulpitis: brief cold sensitivity, no lingering pain, no percussion tenderness and normal apical tissues. Because dentine still covers the pulp, the priority is to avoid an iatrogenic exposure. Selective caries removal, leaving soft or firm dentine pulpally while achieving sound peripheral margins and a durable seal, is therefore appropriate. Direct pulp capping is for an actual pulp exposure and is not indicated merely because exposure is anticipated. Pulpectomy/root canal treatment is unnecessarily invasive for a vital tooth without irreversible symptoms or apical disease. Extraction is disproportionate for a restorable molar, while complete excavation followed only by a temporary restoration both risks exposure and fails to provide the preferred definitive sealed restoration.

Reference: Scottish Dental Clinical Effectiveness Programme. Prevention and Management of Dental Caries in Children: Selective caries removal, 2025. https://www.childcaries.sdcep.org.uk/guidance/dental-techniques/selective-caries-removal/