MDS CONQUER

yeah hi I'm back here with some more stuff what I'm going to cover with for you so today I am going to cover all the aspects of diseases of pulp that are very very important in your the final exam point of view that is neat okay so today I am just going to highlight only the stuff which are important an examination point of view come to the first part okay the cells are present in the pulp they are or under blast fiberglass undifferentiated mesenchymal cells and the differences and the question here is the which is the most common cell which is the most common cell that is present in the pulp answer is you can go for the fibroblasts and which is the second most common cells that are present in the pulp that answer is and differentiate and mesenchymal cells that can be differentiated into any type of cell okay so please make a note about the defense's that are present in the pulp and coming to the nerves particularly I want to concentrate much on the nose nose are very important there are two types of nerves that are present in the pulp one is a delta and second is C fibers okay C fibers are going to be present in the course so you can remember it as C C and a delta fibers are the fibers that are responsible for the pain okay so they can ask a question like which is the most fastest fibers that are present in the dental pulp the answer is a delta okay in general human body they can ask two questions one is pulp and one is in general okay in general the answer is going to be a alpha and in help the answer is going to be a delta okay so please make a note of this the in general the fastest conducting fibers are a alpha fibers engine and in the pulp the fibers are going to conduct the fastest now impulse or a delta fibers and a delta fibers are myelinated whereas C fibers are unmanned later it means the the rate of conduction will also be fast in the a delta when compared to that of the C fibers and they can ask a question like a spear as I already told that see fibers are unmyelinated fibers they are not going to have any myelin shoot of them so whenever a lar local anaesthetic is given the mode of action will be fast in the see fibers because they are unmyelinated so that the action will be fast okay here with the C fibers whereas with a delta fibers the action will go very very slow because they have myelin sheet around them okay coming to the next is about the functions of the bulb it anywhere we are going to go the same stuff in the dental histology but just make a note of these points like these are the four functions of the dental bulb that is in debt to which helps in differentiation of the dental lamellae and the enamel are conformation and form a two it is the one which induces the formation of the dentin okay and next is protect to the sensory receptors with paint will protect the pulp from all the types of students in the form of an a pain whether it is cold heat or anything the pulp is going to give the response in the form of an a pain and the next is like in deck 2 okay next is like defense ooh and repair a token formation repair to our ask a rotted dentin the help of yes now we are going to cover some ecological etiology that are causing the pulper diseases according to the grassman's I just want to stress from the stuff which are important an examination point of view if you go in detail okay you need to cover coming to the trauma where you need to cover these classifications and Anderson's classification of wh-wha and the next important thing is like that is cracked tooth syndrome okay the cracked tooth syndrome is very very important okay it is nothing but an idiopathic it's nothing but an idiopathic incomplete fracture through the body of the lesion causing mild to severe pain on the release of the pressure when the instrument that is used is tool stone okay you will ask the patient to bite on this when he is complaining of any pain on biding on this then there is some sort of epical para down that is are somewhat defecting the pension if the pain is relieved upon biting on this then you can suspect it as in a cracked tooth syndrome and you can suspect or visualize this cracked tooth syndrome with a light okay that is a transamination test where you can see how the crack is propagating and how the crack is going indeed into the tendon or enamel or you can go within a methylene blue dye or two percenters of iodine also to to clinically visualize this crack apart from these there are many other diagnostic tests but these are the parameters where the power sector is going to concentrate and come to the teeth okay coming to the treatment point of view of this cracked tooth syndrome the pulp in this teeth may become necrotic okay we can't account differentiate whether it is a normal apartment we need to go for the pulp vitality test where you need to differentiate whether it's it is necrotic or I mean it's vital or non whiten if the tooth is not completely fractured a full crown restoration is recommended if tooth is factored involving the pulp then you need to go for root canal treatment followed by the post and round restoration so the next category is barometric changes which are associated with the pressure changes a very important note is they can encounter when there is a change above 5000 okay there is a change about 5000 they can encounter but preferably means most commonly you can see this only above 10,000 so these are two MCQs most commonly this complaint is seen only about 10,000 feet okay there will be chronic pulpitis which leading to the adverse conditions so the next is a thermal thermal that is heat produced from the captive preparation that's the reason why we use the water coolant to prevent this an exothermic heat from the setting cements many of the setting cements they release exothermic heat so whenever we need to we need to go with these we need to go for the protectants okay conducting of the heat through the deep feelings without any product two ways there will be chances of this transmission of this thermal confessional heat generated by polishing with the registration particularly amalgam registration okay amalgam where any registration seed is generated so necessary steps to be taken to prevent this heat generation so the next is chemicals that are phosphoric acid or acrylic monomers or air erosion which is called geo to the chemicals so we need to take care of this the net is like bacteria that stock since release from the carries or direct invasion of the pulp from the from the carries or by the drama and this peculiar word is very very important we'll learn it in the next step so this is retrograde infection whatever is coming is ortho grid okay ortho grade means directly from the enamel dentin and involving the bulk retrograde is reverse okay reverse is retrograde and these retrograde infections associated with the pulp are holders named endo pareo lesions okay we'll have a separate class on this end of the relations a meanwhile you just try to know what is a retrograde in ortho grid okay retrograde he is from the this direction and ortho grade will be same goes with like retrograde filling ortho grid filling orthogonal filling retrograde filling we will be with MDA okay so next is like I don't like we're going to discuss about this is all about like bacteria bacteria gaining access through the vascular's mostly this is the definition and it is not mcq bacteria graining the access through the vascular changes okay next next heat produced during the cavity preparations make a note that heat generated by grinding process of the tooth structure is one of the greatest single cause of the pulper damage okay so there should be a care bear is a good histological vasodilatation that and increasing in the interoperable temperature of about 20 degrees for heat may resulting in a reversible pulpit so make a note whenever the temperature changes about 24 feet then there is a chances of irreversible pulpitis means the bulb can not be reverse back it has less than this there can be reversible by this after some times the pulp can reverse back and next is impression making impression making due to the negative pressure I mean there are many types of impression making but due to the negative pressure there will be some sort of pressure that is developed resulting in the Orient of plastic aspiration ok leading to the inflammation so this is the case the negative pressure concept is a reason behind the inflammation of the pulp so these are some of the disorders that are also sated with the animal and dentin which lead to the purple infection that is transmittances invaginate residence in Bosnia - some denser resonators please make a note of these and this is a radical or lingual groove ok peridot peridot ginger will grow which is most common in the case hopefully this is most common the case of namond maxillary central whereas in a parrot or ginger group with the groove extending below the gingival and rendering the pulp that is most common in the case of a neck lateral incisor maxillary lateral incisor and some sort of orthodontic moments can cause a sparkle damage some some periodontal therapies can cause purple damage and these are very important in examination point of view that is sickle cell anemia and we know that the sickle cell anemia the normal half-life of an RPC is 120 days whereas in sickle cell anemia it will be in and around 30 to 40 days it's less okay 30 to 40 days and same goes with a sickle cell anemia sickle cell anemia the most common finding pulper status of a sickle cell anemia is without any like clinical evidence of enamel carries or intentional carriers of a deep lesion you can see that you can see the necrotic pulp means without any lesion the tooth will be very perfect but the teeth on why daddy will be non whiten so there is a peculiar feature of sickle-cell anemia means there will be microvascular racial damage inside the bulb and leading to the necrosis of the pump means the pump doesn't response to the white oddity in the case of sickle-cell anemia same goes with the HEPA source to infection have purged infection there will be at a geminal ganglion means a hat persuade she is going to be much concentrated the trigeminal now and we know that the rhizome nanou is the now that that sensory that gives a sense it is applied for many of the teeth so through this gangly on it may sometimes leads to the damage of multiple bumpity for example the trigeminal had preserved his infection is there so the nose or the nerve which is supplying all that peep a particular group of teeth all the teeth the pom-pom encloses can occur I mean it's not in all the cases but it can be okay it can be same goes with the HIV the dental pulp from a patient with acquired immunodeficiency syndrome as examined to determine the presence of human immunodeficiency virus the results found a higher concentration of an a pro viral HIV DNA okay and the fibroblast has been implicated as a major reservoir for HIV in the body and please make a note this is a very very important point and I have seen an obscure Asian face in PGA coming to the pathophysiology is very important as they have covered few MCQs in APG 2016 okay so we'll learn something related to this is very important concept okay so coming to the vascular changes that occur when palpate is initially started okay so so the main reason of the pain for the pain in the pulp is due to the pulp is a closed encapsulated structure with the pressure increases which leads to the pain so this is a simple logic and measuring the blood flow in the dental pulp is a difficult procedure okay during a blood flow in a closed cavity is a difficult procedure but Kim at all reported 40 percent is okay 40 percent is increasing in the blood flow in a moderately inflamed up okay but 35% is reduction in the peripheral necrotic pulp okay so this is very important this is in a study that was done in the rats so logically whenever there is whenever there is increasing in the blood flow means if the pulp is inflamed there will be definitely increase in the blood flow as well as there will be increasing the pressure in the inflamed pulp means pulp can be vital it may be reversible or irreversible and second thing is like completely necrotic necrotic there will be reduction in the pressure or the reduction in the blood flow there will be no blood if it is necrotic so this is the primary concept that you need to learn from this and followed by the interstitial fluid pressure okay so these all are MCQs which are there in your dental pulse or any sort of mcq books so please try to concentrate on this the healthy dental pulp has an interstitial pressure of five to ten this is the star mcq phi - 10 mm rhe one of the key changes during the inflammation is a movement of the fluids from within the cavity capillaries I mean from within the capillaries to the interstitial space by the law of physics increasing the amount of the fluid in a rigid chamber the rigid chamber is nothing but an encapsulated foam leading to increasing in the pressure the reason for the activation of the nose and the pain in during the pulpitis is increasing the pressure such a pressure raise in the pulp would cause compression of the blood vessels and leading to the vascular statuses and further necrosis of the pump so this table is started okay this is a star table the many questions from this table from 2016 and 2015 or and Axl so first what is the pressure in the normal pump the pressure in the normal pump is around 8 to 5 mm of head G or in and around like 8 10 mm of head G in the case of reversible pulpitis it is 13 mm of Ag in the case of irreversible pulpitis it is thirty four point five mm of Ag in the case of non vital dehydrated it will be negative it will be sucked so it will be negative so just go through these clinical considerations and the nature of the pulp okay but these values are very very important an examination point of view in response to the toxins and injury the afferent fibers in the trigeminal ganglion reaches two important neurotransmitters okay the two neurotransmitters are the system P and the calcitonin gene related peptides okay this is Comet k201 Phi question so please make a note of these two neurotransmitters that are reason that is released okay both both these causes the vasodilation and increasing the permeability leading to the engaging in the powerful pressure causing the compression of the veins and Stratasys and necrosis coming to the classification I just want to finish the things fast okay basing upon the severity and according to the involvement coming basing upon the severity it can be reversible which can be reversed back immediately after the stimulus is removed basing up next is irreversible the reverse which cannot reverse backs once the stimulus is removed there will be generations means make for a pulp degenerative changes starting and the necrosis and bay reversible can be one is like symptomatic and second is asymptomatic okay means symptoms means the pains will be present the symptomatic there will be no sort of any symptoms irreversible can be acute again abnormal response to the cold an abnormal response to the heat and irreversible can be chronic that is asymptomatic with palpable exposure and hyperplastic chronic hyperplastic pulpitis that is nothing but fall polyp and internal resorption too and pulp degeneration that is calcifications and pulp necrosis according to the involvement according to the extent and according to the severity and according to the presence or absence of direct communication with a gentle pulp and the oral an oral amend this is one of the important thing according to the extent they can be focal or sub total or partial pulpitis total or generalized pulpitis according to the severity acute chronic and according to the presence or options of communication that can be open pulp ideas or closed pulpitis these two words are very important in pep Rosetta really like these typical words and palpable diseases coming to the cross pens classification very important we have already discussed about this in the previous video but now I am going to concentrate much and give importance because this is one really the paper set is like okay hot tooth I already already make another hot tooth generally represents to the pump that has been diagnosed as irreversible vampiress means definitely there is a need of root canal treatment with the spontaneous to modern pain a classical example of one type of hot tooth is a patient who is sitting in your in your waiting room okay who is completely or who is keep on taking a ice cube ok cool water or keeping an ice cube on the tooth surface to control the pain this is this is a peculiar thing peculiar thing that you can see like this is the only thing that can give the relief to the patient even even an analgesic or even a local anesthetic cannot relieve only only a cool water can relieve the pain and few consideration should be kept in mind with the teeth diagnosed as in a symptomatic irreversible pulpitis whether adequate local anesthesia has been achieved before the treatment is important so whatever like why we want to proceed if we want to proceed to the root canal treatment definitely a necessity and anesthetic effort is required and that is the first consideration where you need to take a tangent during the hot dog the first consideration should be change the local anesthetic agent logically we use lick no kind right so what to change is the next question the next strategy would be change the injection technique attempting to block the inferior no okay okay the next is like either we need to change the local anesthesia or either we need to change the injection method okay so accessory nerves can have been implicated as a potential reason for the failure of the vasa construction before inferior block before going the die JustGive explain like what are the reason for the carpet okay it is due to the accessory receptors that are present that is T t ax okay show diem generally with sodium channels are the channels that are responsible for the early action but these the typical receptors which are additional receptors they cannot get sensitized with the local anesthetic with the normal lead or kind local anesthetic so to anesthetize these channels we need an accessory that is either we need to go for an F article our boobie what kind either we need to go for these two local anesthetics which has a better action on this TTA X sodium channels when compared with the normal sodium channels and increasing in the volume of the local anesthetic delivery during the eye a and B block has been found not increasing in the incidence of the pulp al and ste share if you don't have a proper where there is no point of getting yesterday's how much local anesthesia a view they will not I mean these receptors will not get any stress the supplementary injection techniques are the intra ligament area injection technique please make a note of this diagram this diagram is very important to notice previously asked as a diagram based question in one of the exam the success of the supplementary para dental injection in helping for in achieving the anesthesia for endodontic procedure has been reported to be in the range of 50 percentage to 96 percent days and next is an interosseous okay interosseous injection uses 1.8 ml of two percenters of lidocaine with one is to one lakh epinephrine and has a ninety-one percent success rate and the mandibular buckling filtration injection with article okay that again is a word you need to catch it and the last lastly sort of infection is in a interoperable injection and the next thing is like the chronic hyperplastic polyp is already discussed in today's exam too so chronic have agnostic malpractice is called as in a pulp polyp one pet is virtual okay causes may be due to the deeper extent to carious lesion leading to the exposure of the egg bulb it is most commonly seen in the case of may children and and and development of a granulation tissue covered by epithelium resulting from a long stand low-grade infection it is a long standard infection and it is low layered infection these are the peculiar words of the chronic hyperplastic polyp eiders usually the symptoms symptoms except during the medication there will be some sort of discomfort due to the pressure that is applied on the vulva a diagnosis most commonly involved the deciduous molars and the first permanent molars of the children lengths polypoid tissue easily bleeds so a bleeding is in a peculiar feature of this there will be very I mean chronic - last pulpitis the blood vessels will be very high so it bleeds fast and the nose will be very less so it doesn't pain and the tooth may responds or not at all to the terminus sometimes the pulp will be white up sometimes and the more current then the normal current is required to elicit the pain so the differential diagnosis is a is a perforating gingival tissue that is nothing but a changeable polyp which injured polyp doesn't bleeds whereas an hyperplastic pulpitis means pulp polly blitzer - the first difference the second difference is whenever you want to diagnose the pulp polyperchon jowl polyp you need to go at the starting point means the stack of the lesion I mean the origin of the lesion so once you go over the once you go for the staff you will get an idea okay it's coming from the gingiva so it is a ginger will bonnet it's coming from the pulpits a panful pollen and the management is the elimination of the polypoid tissue that is nothing but a root canal treatment and followed by the expectation of the pulp and perfecta me have plastic tissue bleeds and can be controlled by pressure or if the tooth structure is very very weak and you can because as the lesions are very deep and open cavities so chances of post hundred-degree situation will be very less so in such situations basing upon the prognosis you can go for the extraction so prognosis is favorable after ended all the treatment but we need to see the amount of tooth structure that is left the next is internal resorption it is an idiopathic slow or fast progressing resort to process occurring in the dentin of the pulp chamber of the root canal the causes can be can be history of trauma okay can be a stray of trauma and the symptoms asymptomatic completely manifested as in a reddish area called a sniping spot okay pin spot are just corners may pink teeth is internal resorption there is one more word like pink disease okay pink disease is make your poisoning so pink t these internal desorption and pink disease is mercury poisoning can also be called as mischief disease okay so just we'll learn it when we are dealing with in a heavy metal poisoning and the diagnosis is is it's very slow it's very slow you can see the internal resorption i mean there is slight the communication externally but it's an internal resorption case slow or it may develop rapid and may cause perforation here i mean in this in this it can it can perforated because they're very thin walls missile and distilling the radiographer and it's most commonly in the maxillary anteriors why if it is if anyone is asking the reason that is trauma even ridiculous cyst is also most common in the mandibular interior's because of the trauma and diagnose during the routine radiographic examinations because the patient is not going to have any symptoms or any sort of things the first symptom that a patient can encounter is is a pink color teeth okay that's what he can complain but occasionally we can see this on the radiographic because and the thickness is during the rector in radiographic examination and the pink spot occurs in the latter stages okay that a patient can recognize radiographically there will be round to all radiolucent areas and the thing you need to concentrate value are going with an internal resorption or explanation because these teeth okay this state right now in the IOP is very typical you can't diagnose it definitely it started as an internal resorption but it communicates extra min to differentiate it you need to apply slow brutal means first of all you need to take a radiograph okay you need to identify the lesion whether it is encountering the periphery and second thing is like you need to change the angulation is you need to go for a meal or a digital view so once you go in for a me shall we is there any change in this resolution see if these radial lucency is moving is moving in a different direction or it moving in our direction then you can diagnose it as an external resorption if it is still in the same place if it is still in the truth's itself then you can diagnose it as an internal desorption so please make a note you can use slope Rufus and the differential diagnosis is yes obviously external resorption you can differentiate the external or internal desorption by using this slope will already discussed come into the management first of all you need to remove the irritant you need to remove the irritant or the etiology that is causing this resorption the irritant is pump so first of all in the first appointment you will expect all the remove the pulp all the pump analytical treatment request / disease gotta watch your technique okay this is a type of observation technique because generally like root canal would have an attacker will have an attack tapper I mean biomechanical preparation whereas in the case of this peculiar internal resorption original resorption you will have in a different morphology of a different way of BMP so for such things you can't go for a normal garbage are lateral condensation technique so it is better to go for a plasticizer but your technique and sometimes it can communicate externally as we discussed so at that time you need some sort of empty air and best-before perforation of the tooth I mean after if it is communicated externally so the chances of the prognosis will be less the next is the pulper degeneration which can be seen in the case of an older individuals as we already discussed the pulp storms or one of the signs of the degenerative changes and which can be seen after 50 years of a general results of persistent mild irritation in the teeth of an egg pulp in early stages normal two vital tests and are not discolored and as degenerative progresses the pulp will not respond and there will be discoloration next is the calcifications we already discussed the pulp stones denticles these are raisins which causes calcifications okay and the pulp stones you can see the pulp stones here there are three types of old stones one is free attached and embedded these pulp stones a symptomatic or asymptomatic and and it will increasing the size as as progress is very important one size of pulp stones will increases because the parents initially started as a thin I mean a small knobs on which there will be deposition of the calcium and it grows in size as it increases it goes on increasing in the size next is diffuse linear classification okay these are not much important okay but make a note and this is very important where where are the pulp stones seen pal stones have seen in the case of net dentin dysplasia type fun peculiarly in type 2 2 and in purple dysplasia 2 and in a multiple perps stone sourcing in the case of rubber man little pulp stones okay this is very very important I'm secure and the Red Cross is nothing but a depth of the pump may be partial or totally depending upon whether the part or the entire pump is involved the causes can be a sequel of inflammatory reaction but these two words are very important there is a coagulative necrosis and liquefaction necrosis coagulative necrosis is a soluble portion of the tissue that is precipitated or converted into a solid material whereas liquefaction necrosis is resulted when a proteolytic and gems convert the tissue into soft and mass liquid or an amorphous Tabriz clinical features there will be no pain because it was already degenerated and the discoloration of the teeth indicated in the pulp death diagnosis radiograph shows a thick laminate aura this is very important and vitality obviously the vitality there will be no response to the vitality management is a root canal treatment followed by the oxidation of the canals and sound with a proper ended on to treatment these are my references I have taken the references from this stuff and thank you I think we covered as much as stuff as possible in the case of Anna diseases of pulp in examination point of view and rest over we are going to solve in our discussion part ok thank you all have a good day