Diagnosis

Pulp & periapical diagnosis

Reversible vs irreversible pulpitis, necrosis and apical periodontitis.

Diagnosis	Key features	Usual treatment
Reversible pulpitis	Sharp pain to cold, resolves within seconds of removing stimulus	Remove caries, restore
Symptomatic irreversible pulpitis	Lingering pain to thermal stimulus, spontaneous or night pain	Pulpotomy/pulpectomy or extraction
Pulp necrosis	No response to sensibility tests	RCT or extraction
Symptomatic apical periodontitis	Tender to bite/percussion	Treat the pulp cause
Acute apical abscess	Swelling, pain, ± systemic signs	Drainage + treat cause
Chronic apical abscess	Sinus tract, little pain	RCT or extraction

Always compare with contralateral and adjacent teeth; take a periapical radiograph.

UK vs US

UK / Europe

SDCEP acute dental problems: pulpotomy is an effective emergency treatment for irreversible pulpitis; antibiotics are not indicated for pulpitis.

United States

AAE diagnostic terminology (above); ADA 2019: no antibiotics for pulpitis or symptomatic apical periodontitis.

Checked against these sources on 2026-10-22. Guidelines change — open the source to confirm.

Summarised from the sources above. Always verify against current local guidelines and the patient's medical history.