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Combined Pulp-Periapical Diagnosis — ORE Part 1 MCQ

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ModerateEndodonticsCombined Pulp-Periapical DiagnosisORE Part 1

A 40-year-old man with no medical history presents with a tooth that has lingering pain to cold for 45 seconds. The pain wakes him at night. There is no swelling or sinus tract. A periapical radiograph shows a widened PDL space at the apex. What is the combined pulp and periapical diagnosis?

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Correct answer: B — Symptomatic irreversible pulpitis with symptomatic apical periodontitis

The diagnosis of symptomatic irreversible pulpitis with symptomatic apical periodontitis is established by: (1) lingering pain to cold (45 seconds exceeds the 30-second threshold for irreversible pulpitis); (2) spontaneous nocturnal pain indicating advanced pulpal inflammation; (3) radiographic widened PDL space confirming apical inflammatory involvement. The absence of swelling and sinus tract does not exclude symptomatic apical periodontitis—the pain and radiographic finding define the diagnosis. Distractors fail because reversible pulpitis causes only transient pain incompatible with nocturnal awakening; necrosis requires absent vitality responses; normal pulp cannot produce lingering thermal pain; and asymptomatic irreversible pulpitis is excluded by clinical symptoms.

Reference: American Association of Endodontists diagnostic framework, as validated in peer-reviewed endodontic literature (Azim et al. 2022, Bjørndal 2017 criteria). International diagnostic standard adopted in UK dental education and ORE examinations. https://pubmed.ncbi.nlm.nih.gov/39521338/