Clinical Manifestations
Reversible pulpitis: sharp, brief pain triggered by cold, sweet, or air stimuli. Pain disappears within a few seconds of stimulus removal.
Irreversible symptomatic pulpitis: spontaneous, severe, throbbing pain often described as the 'worst toothache ever.' Pain is poorly localized, may radiate to ear or jaw, and persists 30+ seconds after stimulus removed.
Pain may be exacerbated by heat and relieved by cold in advanced cases (as cold reduces intrapulpal pressure transiently).
Periapical tenderness is absent in pure pulpitis but may develop if inflammation spreads to periapical tissues.