Clinical symptoms vs. histology

Several investigations have compared the histological status of pulpitic teeth with clinical signs and symptoms. The majority of these studies clearly show that diagnosis of the pulpal status cannot be reliably based on symptoms. Most teeth with irreversible pulpitis are symptom-free.

However, if symptoms are present, continuous, strong pain lasting for more than a few minutes at a time is often regarded as a sign of irreversible pulpitis. Sharp pain of short duration is often caused by hypersensitive dentine or dentine microfractures. In these instances the pulp is usually only reversibly affected.