This process then creates an opening from the pulp to the oral cavity and the pulp tissue will almost balloon into the opening. Pulp polyps (d) are most often found in young teeth that have had the carious process destroy some of the crown of the tooth. Generally in this condition, radiographic bone changes have not yet occurred because the pulp has not yet become necrotic. Irreversible pulpitis (c) presents with spontaneous, intermittent pain and involved vital pulp tissue slowly dying. The radiolucency would proceed in a coronal to apical direction, rather than from the apex outward. This type of abscess would be visible radiographically, but the focus would be on degeneration of bone at the coronal half of the tooth. Another term linked with this would be acute apical abscess.Ĭhronic periodontal abscess (b) is a condition of the periodontium, not the pulp. This condition would result in painful symptoms and sensitivity on biting. When obvious periapical radiolucencies are found on radiographic examination, and there is no recollection of symptoms, the most likely diagnosis is that of chronic apical periodontitis.Īcute suppurative periodontitis (a) involves quick onset of necrotic outflow from the tooth. The necrotic pulp can then exude from the roots and slowly create asymptomatic abscesses. Over time, heavily restored teeth can develop asymptomatic pulpitis leading to pulpal necrosis. What is the most likely diagnosis?Īnswer: E. The patient does not recall any past symptoms. Radiographically, the heavily restored lower right first molar shows apical radiolucencies of both the mesial and distal roots. Sample NBDE II Practice Questions Question 1. Endodontics QID 35150Ī patient presents for routine examination.
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