Which sequence correctly describes inflammatory jaw lesions when the pulp is normal?

• A. Injury → periapical inflammation → pulp death → pulpitis.
• B. Injury → acute or chronic pulpitis → pulp death → periapical inflammation (wide PDL).
• C. Injury → pulp death → acute pulpitis → periapical inflammation.
• D. Injury → pulp death → periapical inflammation → pulpitis.

Answer: (B)

When the pulp is still capable of mounting a response, an injury can first trigger inflammation inside the pulp — pulpitis. If the irritant persists, the pulp tissue eventually undergoes necrosis (pulp death). Once the pulp has died, bacteria and inflammatory mediators can extend into the periapical tissues, causing periapical inflammation and often widening of the periodontal ligament space on radiographs. This sequence—injury leading to pulpitis, then pulp death, then periapical inflammation—is the logical progression for inflammatory jaw lesions that originate with a vital pulp. The other sequences aren’t consistent because once the pulp is dead, pulpitis cannot occur (there’s no living pulp to inflame), and periapical inflammation typically follows pulp necrosis, not precedes it.