Irreversible Pulpitis — ORE Part 1 MCQ

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EasyEndodonticsIrreversible PulpitisORE Part 1

An adult has severe spontaneous pain from a restorable permanent molar. The diagnosis is acute irreversible pulpitis, with no facial swelling or systemic features. What is the most appropriate initial management?

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Correct answer: C — Provide emergency pulp therapy with pulpotomy or pulpectomy

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as E

**A is correct.** Acute irreversible pulpitis in a restorable permanent tooth requires local definitive treatment to remove inflamed pulp tissue and relieve pain: emergency pulpotomy or pulpectomy/root canal therapy is appropriate. SDCEP specifically lists pulpotomy or pulpectomy/root canal therapy for irreversible pulpitis in permanent teeth and advises that antibiotics should not be prescribed for pulpitis. Antibiotics plus analgesia (B) do not treat the inflamed pulp and are not indicated without spreading infection or systemic involvement. Analgesia alone (C) may be adjunctive but is not adequate definitive management. A temporary dressing without pulp access (D) is appropriate for some reversible-pulpitis presentations, not established irreversible pulpitis. Extraction (E) can be considered where retention is unsuitable, but is not the preferred initial option for a restorable tooth when endodontic treatment is feasible.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP), Management of Acute Dental Problems, “Pulpitis” (current online guidance), accessed July 2026. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/pulpitis/