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Endodontics

Endodontic Diagnosis Simplified (OSCE-Ready Guide)

A structured, examiner-friendly method to distinguish reversible pulpitis, irreversible pulpitis, pulp necrosis, and apical periodontitis — exactly how boards want it.

Quick Answers

What is reversible pulpitis?

Mild, sharp, stimulus-triggered pain that stops quickly once the stimulus is removed. No lingering or spontaneous pain.

What is irreversible pulpitis?

Inflammation with prolonged, lingering pain after cold/heat, often spontaneous, and not relieved by stimulus removal.

What is pulp necrosis?

Loss of pulpal vitality with no response to thermal tests; may be asymptomatic until periapical tissues become involved.

What is symptomatic apical periodontitis?

Pain on biting or percussion due to periapical inflammation, with or without radiographic widening of the PDL.

What is asymptomatic apical periodontitis?

Chronic periapical inflammation without pain, usually presenting as a periapical radiolucency.

1. Start with the chief complaint

Examiners always want the patient’s narrative first. It guides test selection and diagnosis.

  • “Sharp pain with cold.”
  • “Throbbing pain wakes me at night.”
  • “Pain when chewing.”

2. Thermal testing: the fastest way to classify pulpal status

Interpret thermal response using duration:

  • Reversible pulpitis: quick, sharp pain → disappears immediately
  • Irreversible pulpitis: lingering pain for 10–30 seconds
  • Pulp necrosis: no response

Cold testing is more diagnostic than heat, especially in early inflammation.

3. Percussion and biting tests

These reflect periapical tissue involvement:

  • Positive percussion: symptomatic apical periodontitis
  • Pain on biting: crack, high occlusion, or apical inflammation

4. Radiographs: interpret with caution

Periapical diagnosis must combine radiographs + symptoms + tests.

  • No radiographic change: reversible or irreversible pulpitis
  • Widened PDL: early apical periodontitis
  • Radiolucency: chronic apical periodontitis

5. OSCE diagnosis template

Use the two-part diagnosis format examiners expect:

  • Pulpal diagnosis → reversible / irreversible / necrosis
  • Periapical diagnosis → normal / symptomatic AP / asymptomatic AP / abscess
  • Justification → tests + symptoms + radiograph

Example OSCE Answer

Pulp diagnosis: Irreversible pulpitis
Periapical diagnosis: Symptomatic apical periodontitis
Justification: Lingering cold pain, spontaneous symptoms, positive percussion, widened PDL.

6. Common mistakes students make

  • Calling every cold sensitivity “irreversible pulpitis.”
  • Diagnosing from radiographs alone.
  • Confusing biting pain with thermal pain patterns.

7. How DentAIstudy can help

DentAIstudy converts this topic into structured recall tools:

  • AI-generated OSCE flows
  • Flashcards for thermal response patterns
  • High-yield one-page notes
  • MCQs for exam practice

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References

All sources are reputable, peer-reviewed, and used internationally by dental boards.

  • American Association of Endodontists (AAE). Endodontic Diagnosis Guidelines.
  • Ricucci D, Siqueira JF. “Pulp Inflammation Diagnosis and Management.” Journal of Endodontics (JOE).
  • Abbott PV. “Apical periodontitis classification and diagnosis.” Australian Endodontic Journal.
  • Neville BW et al. Oral & Maxillofacial Pathology (reference-aligned summary).