Irreversible Pulpitis Cold Test — NDEB AFK MCQ

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EasyEndodonticsIrreversible Pulpitis Cold TestNDEB AFK

A 45-year-old patient presents with pain in the mandibular molar region. Cold testing of tooth 46 produces intense pain that lingers for 60 seconds after removal of the stimulus. Tooth 46 has a large MOD composite restoration placed 6 months ago. What is the most likely diagnosis?

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Correct answer: D — Irreversible pulpitis

Lingering pain (>30 seconds) after removal of a cold stimulus is the hallmark of irreversible pulpitis. The prolonged response indicates that the inflammatory process in the pulp has progressed beyond the point of healing, and the pulp will inevitably become necrotic. The large MOD restoration is a predisposing factor (proximity to pulp, possible microleakage, bacterial penetration). Treatment is either root canal treatment (if the tooth is restorable) or extraction. Direct pulp capping is NOT indicated.

Reference: Torabinejad – Endodontics: Principles and Practice, 6th ed., 2021