Symptomatic irreversible pulpitis — ORE Part 1 MCQ

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ModerateRestorative DentistrySymptomatic irreversible pulpitisORE Part 1

A 46-year-old patient attends with severe spontaneous pain from an upper molar that wakes her at night. Cold testing produces pain that lingers for more than one minute, and the tooth is not mobile. A bitewing shows deep caries close to the pulp but no periapical radiolucency. What is the most likely diagnosis?

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Correct answer: A — Symptomatic irreversible pulpitis

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

The diagnosis is symptomatic irreversible pulpitis (B). The clinical features are diagnostic: spontaneous severe pain disturbing sleep, lingering pain response to cold stimulus (>60 seconds), deep caries with pulpal involvement, intact periapical anatomy (no radiolucency), and normal tooth mobility. Reversible pulpitis (A) presents with pain lasting only 4–5 seconds after cold stimulus removal and resolves when the stimulus is removed—not spontaneous. Acute apical abscess (C) would show periapical radiolucency and often swelling or mobility. Cracked tooth syndrome (D) typically presents with sharp pain on release of bite pressure, not spontaneous thermal pain. Chronic periodontitis (E) is a periodontal, not endodontic, condition and does not produce the acute thermal response described. The lingering cold response >60 seconds is the key discriminator between reversible and symptomatic irreversible pulpitis.

Reference: Royal College of Surgeons FDS & SDCEP: Symptomatic irreversible pulpitis is recognised as severe emergency dental pain characterised by spontaneous pain and lingering (>10 seconds) response to thermal stimuli. UK clinical diagnosis aligns with AAE consensus criteria (2013) and is applied within UK general and specialist dental practice for emergency triage and endodontic referral. https://www.rcseng.ac.uk/-/media/files/rcs/fds/guidelines/recommendations-for-restorative-dentistry-covid19.pdf