Reversible pulpitis in a permanent molar — ORE Part 1 MCQ

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ModerateRestorative DentistryReversible pulpitis in a permanent molarORE Part 1

A 29-year-old patient reports brief sharp pain from the lower right first molar when drinking cold water. The pain settles within seconds. There is a deep occlusal carious lesion, the tooth is not tender to percussion, and the periapical radiograph shows no periapical change. What is the most likely diagnosis?

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Correct answer: D — Reversible pulpitis

The diagnosis is reversible pulpitis. The clinical picture is pathognomonic: cold pain that resolves within seconds of stimulus withdrawal, absence of spontaneous pain, negative percussion test, normal periapical radiograph, and underlying deep caries. According to SDCEP diagnostic criteria, reversible pulpitis presents with a positive sensibility response (cold pain) and no percussion tenderness, with pain resolving rapidly after stimulus removal. Symptomatic irreversible pulpitis would exhibit spontaneous or lingering pain after cold stimulus removal—neither present here. Acute apical abscess presents with spontaneous pain, swelling and percussion tenderness. Chronic apical periodontitis shows periapical radiographic change (excluded by normal X-ray). Cracked tooth syndrome produces pain on release of biting pressure, not cold-triggered transient pain. The key discriminator is the rapid resolution of pain after stimulus withdrawal, which defines reversibility.

Reference: SDCEP MADP Pulpitis guidance (madp.sdcep.org.uk/content/conditions-library/pulpitis.html); confirmed by clinical diagnosis criteria in peer-reviewed endodontic literature (NCT07578662, PubMed 30903124). https://madp.sdcep.org.uk/content/conditions-library/pulpitis.html