Question

19 yo man-deep carious lesion on mandibular first molar. No hx of spontaneous pain, but tooth is sensitive to sweets, cold, or chewing on quadrant. After exam, tooth responds to EPT and not sensitive to percussion or palpatation.

The definitive diagnosis is

A. reversible pulpitis and acute apical periodontitis.
B. reversible pulpitis and normal periapical tissues.
C. irreversible pulpitis and acute apical periodontitis.
D. irreversible pulpitis and normal periapical tissues.
E. none of the above. There is not enough information to make a definitive diagnosis.

Answer 1

The correct definitive diagnosis for the patient with a deep carious lesion without spontaneous pain but with sensitivity to sweets, cold, and chewing is reversible pulpitis and normal periapical tissues.

Step-by-step explanation:

The definitive diagnosis for a 19-year-old man with a deep carious lesion on the mandibular first molar, who has no history of spontaneous pain but experiences tooth sensitivity to sweets, cold, or chewing on the affected quadrant, is B. reversible pulpitis and normal periapical tissues. The tooth's response to Electric Pulp Testing (EPT) and lack of sensitivity to percussion or palpation suggest that the pulp is inflamed but can heal (reversible pulpitis), and the surrounding tissues of the tooth are healthy (normal periapical tissues). Acute apical periodontitis and irreversible pulpitis are ruled out due to the absence of spontaneous pain and sensitivity to percussion, which are typical for these conditions.

Conditions such as trench mouth, or acute necrotizing ulcerative gingivitis, are characterized by severe periodontitis with symptoms of gum erosion, ulcers, and substantial pain with chewing, which do not match the presented case. Additionally, the typical response of a tooth affected by irreversible pulpitis often includes spontaneous pain, which the patient does not experience. Therefore, the most accurate choice is reversible pulpitis with normal periapical tissues.