[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Dentistry](https://durgical.com/en/dentistry/) › [Endodontics](https://durgical.com/en/dentistry/areas/endodontics/) › Endodontic diagnosis: naming pulp and apical disease # Endodontic diagnosis: naming pulp and apical disease - Examination Every endodontic diagnosis has two parts: the state of the pulp and the state of the tissues around the root tip. Together they decide the treatment. Updated Nov 12, 2026 ## Key points - Two diagnoses: pulp and apical. - Lingering or spontaneous pain means irreversible pulpitis. - A sinus tract means a chronic apical abscess. ## What it is Endodontic diagnosis names two things separately: the pulp (inside the tooth) and the apical tissues (bone and ligament around the root tip). The pulp diagnosis comes mainly from the history and the response to cold; the apical diagnosis from percussion, palpation, swelling and the radiograph. Standard terms make treatment decisions and records consistent. ## Findings and interpretation - Pulp: normal; reversible pulpitis (short pain to cold that stops); symptomatic irreversible pulpitis (lingering or spontaneous pain); asymptomatic irreversible pulpitis (deep caries reaching the pulp, no pain). - Pulp: necrosis (no response to tests); previously treated (root filled); previously initiated therapy (partly treated). - Apical: normal; symptomatic apical periodontitis (pain to bite or percussion); asymptomatic apical periodontitis (radiolucency, no symptoms). - Apical: acute apical abscess (rapid onset, pain, swelling); chronic apical abscess (little pain, a draining sinus tract). - Condensing osteitis: a diffuse radiopaque area around the apex from low-grade inflammation. ## How it is done - Take the pain history: what starts it, how long it lasts after the stimulus, whether it is spontaneous or wakes the patient, and pain on biting. - Look for caries, deep or leaking fillings, cracks, swelling and sinus tracts; probe the gums around the tooth. - Test the suspect tooth and its neighbours and the same tooth on the other side with cold; note whether pain lingers. - Percuss and palpate over the root tips. - Take a periapical radiograph (and CBCT only when it will change management). - Write a pulp diagnosis and an apical diagnosis. ## Common mistakes - A single test can mislead: necrotic multirooted teeth, calcified canals and recent trauma give false results. - Referred pain is common: the painful tooth may be in the other jaw on the same side. - Radiographs miss early apical periodontitis until bone has been lost. ## Next step / Initial management - Record a pulp diagnosis and an apical diagnosis for every tooth before treatment. - Reversible pulpitis: remove the cause and restore; irreversible pulpitis or necrosis: refer to the dentist for pulpotomy, root canal treatment or extraction. - Acute apical abscess with spreading swelling, fever or trismus: urgent drainage; refer the same day. ## Test yourself Think of the answer, then tap the question to see it. ## What distinguishes reversible from irreversible pulpitis on history? In reversible pulpitis pain to cold stops within seconds of removing it; in irreversible pulpitis it lingers or comes on spontaneously. ## What is the apical diagnosis for a tooth with a draining sinus tract and little pain? Chronic apical abscess. ## Which two tests give the apical diagnosis? Percussion and palpation over the root tip, together with the radiograph. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/dentistry/endodontic-diagnosis-naming-pulp-and-apical-disease/) ## Connections ## Related 5 - [Pulp and periapical tests: cold, heat, percussion and palpation](https://durgical.com/en/dentistry/pulp-and-periapical-tests-cold-heat-percussion-and-palpation/) - [Pulpitis: reversible or irreversible](https://durgical.com/en/dentistry/pulpitis-reversible-or-irreversible/) - [Pulp necrosis, apical periodontitis and the dental abscess](https://durgical.com/en/dentistry/pulp-necrosis-apical-periodontitis-and-the-dental-abscess/) - [Root canal treatment: access, cleaning, shaping and filling](https://durgical.com/en/dentistry/root-canal-treatment-access-cleaning-shaping-and-filling/) - [Dental imaging: bitewing, periapical, panoramic and CBCT](https://durgical.com/en/dentistry/dental-imaging-bitewing-periapical-panoramic-and-cbct/) ## Related conditions 1 - [Dental caries](https://durgical.com/en/conditions/dental-caries/) ## In Pharmacology 1 - [Ibuprofen](https://durgical.com/en/pharmacology/ibuprofen/) [← All of dentistry](https://durgical.com/en/dentistry/) Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once. Sources: [Diagnosis consensus among endodontic specialists and general practitioners: An international survey and a proposed modification to the current diagnostic terminology](https://pmc.ncbi.nlm.nih.gov/articles/PMC9826047/) (International Endodontic Journal (PMC open access), 2022); [Apical Periodontitis](https://www.ncbi.nlm.nih.gov/books/NBK589656/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Endodontic Periapical Lesion: An Overview on the Etiology, Diagnosis and Current Treatment Modalities](https://pmc.ncbi.nlm.nih.gov/articles/PMC7398993/) (European Endodontic Journal (PMC open access), 2020); [Anatomy, Head and Neck, Dental Pulp](https://www.ncbi.nlm.nih.gov/books/NBK537112/) (StatPearls Publishing (NCBI Bookshelf), 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/dentistry/endodontic-diagnosis-naming-pulp-and-apical-disease/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/dentistry/endodontic-diagnosis-naming-pulp-and-apical-disease/