Which test result supports a diagnosis of symptomatic irreversible pulpitis?

• A. Spontaneous pain and cold sensitivity
• B. No spontaneous pain
• C. Pain on percussion only
• D. Normal tooth vitality

Answer: (A)

Symptomatic irreversible pulpitis is indicated when the pulp is inflamed enough to be unable to heal, yet still alive, so the patient experiences spontaneous pain and a strong, lingering reaction to cold. Spontaneous pain shows the inflammatory process is active even without a trigger, and cold sensitivity that persists after removing the stimulus reflects heightened nerve irritability and ongoing inflammation within a vital pulp. If there were no spontaneous pain, or if pain occurred only with percussion (which points more to periradicular inflammation) or if the tooth tested normal, those findings would not fit symptomatic irreversible pulpitis. So a presentation of spontaneous pain with cold sensitivity best supports this diagnosis.