Diagnosis Signs and Symptoms

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Formulation of Pulpal and Periradicular Diagnoses1


Signs and Symptoms

Radiographic Appearance

Response to Pulp Tests2

Response to Periapical Tests3

Pulpal Diagnosis

Normal Pulp (NP)4



Reversible Pulpitis (RP)

May have Sharp Pain


Symptomatic Irreversible Pulpitis (SIP)5

Sharp Pain, but may have Deep, Dull, Gnawing Pain, Spontaneous Pain, Referred Pain, or a Past History of Pain

Response (may be extreme and/or lingering)

Asymptomatic Irreversible Pulpitis (AIP)5

None, but may have a Past History of Pain


Pulp Necrosis (PN)

No Response

No Response

Previously Treated (PT)6

No Response

No Response

Previously Initiated Therapy (PIT)6

No Response

With or Without Response

Periradicular (Periapical) Diagnosis7

Normal Apical Tissues (NAT)8

None (WNL)9

No Periapical Changes

None (WNL)

Symptomatic Apical Periodontitis (SAP)10


1. No Significant Changes (may have widened pdl) or 2. Apical Radiolucency

Painful Response

Asymptomatic Apical Periodontitis (AAP)11

None (WNL)

Apical Radiolucency

None (WNL)

Acute Apical Abscess (AAA)12

Swelling With or Without Pain

With or Without Apical Radiolucency

With or Without Painful Response

Chronic Apical Abscess (CAA)13

Sinus Tract Without Pain (usually)

With or Without Apical Radiolucency

Usually No Response

Condensing Osteitis (CO)14

With or Without Pain

Radiopacity, may be framing a coexistent radiolucency

With or Without Response

1 From the AAE Consensus Conference of Recommended Diagnostic Terminology: Recommended Terms, 1634 JOE — Volume 35, Number 12, December 2009. Previous terms used by the UNC Department of Endodontics were from a compilation of Walton RE and Torabinejad M. Diagnosis and Treatment Planning In: Principles and Practice of Endodontics, RE Walton and M Torbinejad eds., WB Saunders Co., 3rd edition, 2002, pp. 49-70 and Trope M and Sigurdsson A. Clinical Manifestations and Diagnosis In: Essential Endodontology: Prevention and Treatment of Apical Periodontitis, D Orstavik and TR Pitt Ford eds., Blackwell Science, 1998, pp. 157-178.

2 Pulp Tests are sensitivity tests that include thermal (hot and cold) and electrical (EPT) stimulation and responses are categorized as None (-), Responsive (+), Hyper-Responsive (++), or Not Applicable (NA).

3 Periapical (Periradicular) Tests include percussion and palpation and are categorized as None (-), Mild (+), Moderate (++) or Severe (+++).

4 Also referred to as Healthy Pulp (HP) UNC 2006.

5 Also referred to as Irreversible Pulpitis, Symptomatic or Asymptomatic Pulptitis; Note: Hyperplastic Pulpitis (Pulp Polyp) is a form of Irreversible Pulpitis.

6 More a finding or observation, but used as a diagnostic term.

7 Radiolucencies and/or Radiopacities of Non-Endodontic Origin that normally respond to Pulp Tests are not included. Other terms include Non-Endodontic Pathosis or Lesions of Non-Endodontic Origin.

8 Also referred to as Healthy Periodontium, Normal Periodontium.

9 WNL = Within Normal Limits; usually includes none to mild signs, symptoms, or responses.

10 Also referred to as Acute Apical Periodontitis, Acute Periradicular Periodontitis, Subacute Periradicular Periodontitis. When associated with an apical radiolucency, also termed Acute Exacerbation of Acute Apical Periodontitis (AECAP) UNC 2006.

11 Also referred to as Chronic Apical Periodontitis, Chronic Periradicular Periodontitis.

12 Also referred to as Apical Periodontitis with Abscess, Acute Periradicular Abscess.

13 Also referred to as Apical Periodontitis with Sinus Tract, Chronic Periradicular Abscess, Suppurative Periradicular Periodontitis, Suppurative Apical Periodontitis.

14 Also referred to as Sclerotic Apical Periodontitis, Condensing Apical Periodontitis, Focal Sclerosing Osteomyelitis, Periradicular Osteosclerosis.

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