Lecture by Dr. Sohail Abbas Khan http://helpingdentists.blogspot.com

1. Objectives
The objectives of endodontic therapy are:
1. Elimination of pain and/or infection from the tooth and
surrounding periapical tissue.
2. Obliteration of the canals.
3. Restoration of the crown for the completed endodontically
treated tooth

2. Pain in Restored Teeth :
• Inadequately Lined Restorartion.
• Secondary Expansion of Amalgam.
• Leaking Restoration.
• Fractured restoration.
• Cracked Tooth.
• Galvanism.
• Temporary restorations.
• Barodontalgia.

3. Pain Due to Factors
Affecting Enamel & Dentin
Enamel :
• Damaged Enamel.
• Shock from Dental Unit.
Dentin :
• Pain in Normal Teeth.
• Pain in Teeth with disease.
• Pain in Restored Teeth.

4. Pain in Normal Teeth
Dentin :
• Sensitive Dentin.
• Sensitivity of Dentino-Enamel
Junction.

5. Pain Due to Pulp Disease :
• Pulp Exposure.
• Hyperemia.
• Acute Pulpitis.
• Chronic Pulpitis.
• Pulp Gangrene.
• Pulp Necrosis.
• Pulp Concussion.
• Internal Resorption.
• Calcification.

6. Investigation of Pain
Causes :
• What complaint of
pain ?
• What site of pain ?
• When pain was first
noted ?
• What start the pain ?
• When the pain occurs ?
• What frequency of
pain ?
• What pain intensity ?
• What quality of pain ?
• What relieve the pain ?

7. Features of Dentinal
Pain :
• Localization.
• Onset.
• Quality.
• Quantity.
Two Phases of Pain.
Apparent Volume of pain.

8. Vitality Tests :
• Mechanical stimulation
• Application of heat
• Application of cold
• Comparative test
• Electric test
• Pain on percussion
• Local anaesthetic test
• Thermography
• Photoplethysmogram
• Pulp haemogram

9. Threshold
Values of Teeth
• Thermal threshold 26.4 C 47.7C
• Osmotic threshold 25Atm
• Pressure threshold 2Kg/cm2
• Electrical threshold 2.5, 2.96, 3.37, 4.95
• Differential threshold

10. Continued…
• Influence of age on the threshold value
• Influence of sex on the threshold value
• Influence of ongoing activity on the
threshold value
Threshold
Values of Teeth

11. External Stimuli
Provoking Pain in Teeth:
• Thermal Stimuli.
• Osmotic Stimuli.
• Mechanical
Stimuli.
• Electrical
Stimuli.

12. Pain in Diseased Tooth :
• Dental Caries.
• Trauma & Operative
procedures.
• Effect of repeated
Stimulation.
• Effect of time from
preparation.
• Effect of Cavity Depth.
• Effect of age.
• Effect of Secondary Dentin.
• Attrition, Abrasion &

13. Pain of Dental Origin :
• Teeth.
• Pulp.
• Periodontal Origin.
• Pain due to factors in jaws.
• Pain due to Disturbance of Masticatory
System.
• Soft Tissue Lesion s.
• Trigeminal Neuralgia.
• Referred Pain.
• Atypical Facial Pain.

14. Pain of Dental Origin
Somatic Pain Common visceral
Diseases
Visceral Pain
• Bone Infection
• Joint Trauma
• Skin Joint disfunction
• Muscles etc. Neoplasia

15. Hyperalgesia
• Chemical mediators of pain.
a) Intra cellular algogenic
substances.
b) Extra cellular algogenic
substances
• The Prostaglandins.

16. Analgesic
Relieving in Dental Pain
MILD OR MINORMILD OR MINOR
Salicylates:-
Asprin
Aniline Group:-
Paracetmol B.P
Anthranilic Acid Dervative:-
Mefenamic acid
Phenylalkanoic acids
2-(4-isobutylphenyl) propionic acid
MEDIUM POTENCYMEDIUM POTENCY
Dihydrocodeine
POWERFUL OR MAJORPOWERFUL OR MAJOR
Pentazocine
Methadone B.P
Pethidine B.P
Morphine B.P

17. Patient’sPatient’s
description ofdescription of
painpain
Pain only onPain only on
percussionpercussion
Pain onPain on
percussion &percussion &
from heatfrom heat
Pain on percussion &Pain on percussion &
from coldfrom cold
Pain on percussion & fromPain on percussion & from
both heat & coldboth heat & cold
IntermittentIntermittent
mildmild
Normal Pulp 1Normal Pulp 1
Acute pulpitis 2Acute pulpitis 2
Chronic pulpitis 2Chronic pulpitis 2
Degeneration 2Degeneration 2
NecrosisNecrosis
11
Acute pulpitis 1Acute pulpitis 1
Chronic pulpitis 2Chronic pulpitis 2
Degeneration 1Degeneration 1
Necrosis 1Necrosis 1
Normal pulp 1Normal pulp 1
Chronic pulpitis 1Chronic pulpitis 1
Necrosis 1Necrosis 1
IntermittentIntermittent
severesevere
Acute withAcute with
chronic pulpitis 1chronic pulpitis 1
Chronic pulptis 1Chronic pulptis 1
Localized acuteLocalized acute
pulpitis 2pulpitis 2
Acute pulpitis 1Acute pulpitis 1
Acute pulpitis 2Acute pulpitis 2
Acute with chronicAcute with chronic
pulpitis 2pulpitis 2
Chronic pulpitis 2Chronic pulpitis 2
Nechrosis 1Nechrosis 1
Normal pulp 2Normal pulp 2
Localized acute pulpitis 5Localized acute pulpitis 5
Acute pulpitisAcute pulpitis
44
Acute with chronic pulpitis 5Acute with chronic pulpitis 5
Chronic pulptisChronic pulptis
11
DegenerationDegeneration
11
ConstantConstant
MildMild
Normal PulpNormal Pulp
11
Localized acuteLocalized acute
pulpitispulpitis
11
Nechrosis 2Nechrosis 2
Localized acuteLocalized acute
pulpitis 1pulpitis 1
Localized acute pulpitis 1Localized acute pulpitis 1
ConstantConstant
SevereSevere
Acute pulpitis 2Acute pulpitis 2
Chronic pulpitis 2Chronic pulpitis 2
Necrosis 2Necrosis 2 Degeneration1Degeneration1 Degeneration 1Degeneration 1
Normal pulpNormal pulp
33
Localized acute pulpitisLocalized acute pulpitis
99

18. PAIN
• Intensity Theory
• Specificity Theory
• Protopathic & Epicritic Theory
• Pattern Theory
• Gate Control Theory