Tooth #12 presents with spontaneous pain, sensitivity to cold, no pain on percussion, and no periapical radiolucency. Which diagnosis best fits these findings?

• A. Necrotic pulp/Symptomatic apical periodontitis
• B. Reversible pulpitis
• C. Symptomatic irreversible pulpitis/Normal apical tissues
• D. Acute apical abscess

Answer: (D)

Spontaneous pain with persistent cold sensitivity and no percussion tenderness or periapical radiolucency fits inflammation confined to the pulp with the apical tissues still normal. Spontaneous pain indicates irreversible pulp inflammation, while the tooth still responds to vitality tests (cold) means the pulp is alive but inflamed. The absence of percussion pain and lack of radiographic evidence of a periapical lesion show the periapical tissues are not involved yet. If the tooth were necrotic or had an acute apical abscess, you’d expect loss of vitality and signs at the periapex such as percussion tenderness, swelling, or a radiolucency. Therefore, the best fit is symptomatic irreversible pulpitis with normal apical tissues.