A patient reports spontaneous throbbing pain in tooth 4.6 that keeps him awake. Cold sets off intense pain that lasts for over a minute after the stimulus is removed. The tooth is not tender to percussion, and the periapical radiograph is normal. What is the most appropriate pulpal diagnosis?

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Explanations

Spontaneous pain and lingering pain after a thermal stimulus are hallmarks of symptomatic irreversible pulpitis. In reversible pulpitis, the pain goes away within seconds of removing the stimulus. A necrotic pulp would not respond to cold.

Source: AAE Consensus Conference Recommended Diagnostic Terminology (J Endod 2009) — oneguy