What indicates the presence of acute irreversible pulpitis with symptomatic apical periodontitis?

• A. Asymptomatic with no response to stimuli
• B. Lingering pain from cold stimulus with percussion tenderness
• C. Negative radiograph findings
• D. Normal pulp vitality tests

Answer: (B)

The indication of acute irreversible pulpitis with symptomatic apical periodontitis is characterized by lingering pain from cold stimuli coupled with percussion tenderness. In this clinical scenario, the lingering pain suggests that the pulp is inflamed and unable to heal, which corresponds to irreversible pulpitis. The reaction to cold, where the pain lasts after the stimulus is removed, is a hallmark symptom, showing the pulp's sensitivity and underlying inflammation.

Additionally, percussion tenderness signifies that there is likely an inflammatory process affecting the apical tissues, which supports the diagnosis of symptomatic apical periodontitis. This localized discomfort upon percussion indicates that the inflammation extends beyond the pulp into the surrounding periapical area, which is a key aspect of the condition being evaluated.

The combination of these findings—lingering pain from cold stimuli and tenderness upon percussion—clearly signifies a severe pulp condition with associated periapical issues, solidifying the diagnosis of acute irreversible pulpitis with symptomatic apical periodontitis. The other options do not demonstrate the acute inflammatory response or the symptoms necessary to confirm this specific diagnosis.