If a patient experiences severe, spontaneous pain in a lower molar that wakes them at night, what condition is likely?

Severe, spontaneous pain that disturbs a patient’s sleep, particularly in the context of a lower molar, is a hallmark characteristic of acute pulpitis. This condition occurs when the dental pulp becomes inflamed, usually due to bacterial infection or extensive caries. The pain associated with acute pulpitis is typically described as sharp, intense, and often exacerbated by thermal stimuli (such as hot or cold foods). The spontaneous nature of the pain, especially at night when the patient is lying down, further supports this diagnosis, as increased blood flow can exacerbate the pulpal pressure and pain during rest.

While other conditions such as chronic pulpitis, a dental abscess, or pulp necrosis can involve some degree of pain, they usually present differently. Chronic pulpitis tends to evolve over time with less intense pain and is often less acute. A dental abscess can also cause pain, but it is typically associated with swelling, fever, or a noticeable drain in the gum area. Pulp necrosis, on the other hand, would result in a lack of vital pulp tissue and often presents with less severe pain, as the nerve endings are damaged.

Thus, when considering the descriptions and symptoms, acute pulpitis fits best with the presentation of severe