1. Irreversible pulpitis is an inflammatory condition of the pulp that is symptomatic or asymptomatic and caused by noxious stimuli. It can be acute or chronic.
2. Acute pulpitis is characterized by an intense inflammatory response causing teeth to be extremely sensitive to thermal changes, with hot or cold stimuli causing persisting pain.
3. Late stage irreversible pulpitis presents with throbbing pain that keeps patients awake at night, with cold providing relief and heat making the pain worse, often with referred pain and periapical changes visible on radiographs.
This lecture, which oriented to the level of mind of undergraduate students, discuss the topic of pulpectomy, its indications, contraindications, and procedural steps.
Visit us on Facebook:
https://www.facebook.com/iraqi.Dental.Academy
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
This lecture, which oriented to the level of mind of undergraduate students, discuss the topic of pulpectomy, its indications, contraindications, and procedural steps.
Visit us on Facebook:
https://www.facebook.com/iraqi.Dental.Academy
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
This short presentation discuss very important subject in endodontic field, which is the complications that most commonly occur during root canal treatment, like sodium hypochlorite accident and air emphysema and others. management of these complications is also discussed.
As an intracanal medicament
Definition
Clinical application
Mechanism of action
Vehicles
Placement of Calcium hydroxide paste
Dentin and Calcium hydroxide
Effect of Calcium hydroxide on clinical outcome
Calcium hydroxide and Chlorhexidine
Calcium hydroxide and Sodium Hypochlorite
Removal of Calcium hydroxide from the canal
When to replace Calcium hydroxide dressing?
Calcium hydroxide and CO2
Toxicity
As a Root canal Sealer
Clinical significance
Classification
Composition
Properties
Leakage
Solubility
- In tissue fluids
- In chemical solvent
Biocompatibility
Antimicrobial
Toxicity
Conclusion
References
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Bevels and flares are very important components of resin restoration procedure. This presentation focuses on bevels and flares in restorative procedure.
In this lecture I explain in step-by-step fashion the basics of Apexogenesis procedure. a photo guide is attached to the guide to aid in better understanding of the topic
Double seal in endodontics and conservative dentistrydrepsitaghosh
Introduction:
The ultimate goal of root canal therapy is to conquer the complex root canal system by perfect obturation. The primary objectives of operative endodontics are total debridement of the pulpal space, development of a fluid–tight seal at the apical foramen and total obturation of the root canal. Earlier, root canals have been reported to be filled with Amalgam, Asbestos, Balsam, Bamboo, Cement, Copper, Gold Foil, Iron, Lead, OxyChloride of Zinc, Paraffin, Pastes, Plaster of Paris, Resin, Rubber, Silverpoints, Tin foil etc., Among all these materials tried, none of them met the requirements of an ideal obturating material.
Even after a three dimensional obturation of the system, coronal restoration may fail to provide a perfect seal and may permit microorganism & their toxins along the canal walls to their periapical tissue, leading to the failure of the treatment. So the quality of the coronal seal should be adequate to prevent micro leakage in to the canal space.Thus the concept of double seal came . Lack of satisfactory temporary restoration during endodontic therapy ranked second amongst the contributing factors in continuing pain after commencement of treatment.
Over the years various materials referred to as ‘Intra-orifice barriers’ have been sought by investigators to prevent coronal micro leakage & help produce a secondary seal for obturated canal. Thus along with time many sealing material for coronal sealing was tested. This also implies that an adequate coronal filling or restoration be placed to prevent oral bacterial microleakage. It has been shown that endodontic treatment success is dependent both on the quality of the obturation and the final restoration.1
Definition:
A DOUBLE seal consisting of gutta percha underneath material such as temporary cement ; used to close the coronal opening in a tooth during endodontic treatment. A DOUBLE seal consisting of gutta percha underneath material such as temporary cement ; used to close the coronal opening in a tooth during endodontic treatment.
• Many materials can be used to achieve some of these goals for effective inter-
appointment temporization. It is essential to have adequate knowledge of temporization techniques and material properties in order to satisfy a wide variety of clinical requirements such as time , occlusal load and wear ,complexity of access and absence of tooth structure.
Coronal 3-4 mm should be left for the placement of this double seal.
This short presentation discuss very important subject in endodontic field, which is the complications that most commonly occur during root canal treatment, like sodium hypochlorite accident and air emphysema and others. management of these complications is also discussed.
As an intracanal medicament
Definition
Clinical application
Mechanism of action
Vehicles
Placement of Calcium hydroxide paste
Dentin and Calcium hydroxide
Effect of Calcium hydroxide on clinical outcome
Calcium hydroxide and Chlorhexidine
Calcium hydroxide and Sodium Hypochlorite
Removal of Calcium hydroxide from the canal
When to replace Calcium hydroxide dressing?
Calcium hydroxide and CO2
Toxicity
As a Root canal Sealer
Clinical significance
Classification
Composition
Properties
Leakage
Solubility
- In tissue fluids
- In chemical solvent
Biocompatibility
Antimicrobial
Toxicity
Conclusion
References
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Bevels and flares are very important components of resin restoration procedure. This presentation focuses on bevels and flares in restorative procedure.
In this lecture I explain in step-by-step fashion the basics of Apexogenesis procedure. a photo guide is attached to the guide to aid in better understanding of the topic
Double seal in endodontics and conservative dentistrydrepsitaghosh
Introduction:
The ultimate goal of root canal therapy is to conquer the complex root canal system by perfect obturation. The primary objectives of operative endodontics are total debridement of the pulpal space, development of a fluid–tight seal at the apical foramen and total obturation of the root canal. Earlier, root canals have been reported to be filled with Amalgam, Asbestos, Balsam, Bamboo, Cement, Copper, Gold Foil, Iron, Lead, OxyChloride of Zinc, Paraffin, Pastes, Plaster of Paris, Resin, Rubber, Silverpoints, Tin foil etc., Among all these materials tried, none of them met the requirements of an ideal obturating material.
Even after a three dimensional obturation of the system, coronal restoration may fail to provide a perfect seal and may permit microorganism & their toxins along the canal walls to their periapical tissue, leading to the failure of the treatment. So the quality of the coronal seal should be adequate to prevent micro leakage in to the canal space.Thus the concept of double seal came . Lack of satisfactory temporary restoration during endodontic therapy ranked second amongst the contributing factors in continuing pain after commencement of treatment.
Over the years various materials referred to as ‘Intra-orifice barriers’ have been sought by investigators to prevent coronal micro leakage & help produce a secondary seal for obturated canal. Thus along with time many sealing material for coronal sealing was tested. This also implies that an adequate coronal filling or restoration be placed to prevent oral bacterial microleakage. It has been shown that endodontic treatment success is dependent both on the quality of the obturation and the final restoration.1
Definition:
A DOUBLE seal consisting of gutta percha underneath material such as temporary cement ; used to close the coronal opening in a tooth during endodontic treatment. A DOUBLE seal consisting of gutta percha underneath material such as temporary cement ; used to close the coronal opening in a tooth during endodontic treatment.
• Many materials can be used to achieve some of these goals for effective inter-
appointment temporization. It is essential to have adequate knowledge of temporization techniques and material properties in order to satisfy a wide variety of clinical requirements such as time , occlusal load and wear ,complexity of access and absence of tooth structure.
Coronal 3-4 mm should be left for the placement of this double seal.
Abdominal pain is one of common problems
encountered by doctors, either in primary or
secondary health care (specialists). It may be
mild, but it may also a life-threatening sign. It
has been estimated that almost 50% adults have
experienced abdominal pain. In general, abdominal pain is categorized
based on the onset as acute or chronic pain.
Sudden onset of abdominal pain that lasts for less
than 24 hours is considered as acute abdominal
pain.
The problems of a surgeon
If 'I' operate 'and 'the' problem 'is' not 'surgical, Pt
exposed 'to' unnecessary 'risk ,'anesthetic,'etc.'
Risks 'greater' with 'concomitant 'illness,'older 'age'
If 'I' do 'not' operate 'and' problem 'is' surgical, 'patient 'at'
risk 'because' of 'wrong' therapy.'
Again 'the' older 'patient 'is' under 'greater' burden.'
Similar to PULP PERIAPICAL PATHOSIS. 111pptx.pdf (20)
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Evaluation of antidepressant activity of clitoris ternatea in animals
PULP PERIAPICAL PATHOSIS. 111pptx.pdf
1. Pulp &
Periapical
Pathosis
Dr. Hadil Abdallah Altilbani
BDS Santiago de Compostela University Spain.
MSc. University of Valencia Spain.
Department of Endodontics University of Palestine .
3. according to:
❑ Severity & duration:
i) Acute
ii) Chronic
iii)Subacute
❑ Presence or absence of symptoms:
i)Symptomatic
ii)Asymptomatic
❑ Ability to heal:
i)Reversible
ii) Non reversible
❑ Another classification of acute & chronic based on presence or absence of direct communication
between pulp & oral environment:
- Open pulpitis (pulpitis aperta) communicated exist.
- Closed pulpitis (pulpitis clausa) no communication exist.
❑ Based on extend
• Focal /Partial pulpitis
• Total /Generalized pulpitis
Inflammatory Diseases
Of The Pulp
4. CLASSIFICATION OF PULPAL DISEASES
According to Grossman
I] PULPITIS
a) REVERSIBLE
1. Acute (symptomatic)
2. Chronic (asymptomatic)
b) IRREVERSIBLE
1. Acute
- Abnormally responsive to cold
- Abnormally responsive to heat
2. Chronic
- Asymptomatic with pulp exposure
- Hyperplastic pulpitis
- Internal resorption
• II] PULP DEGENERATION
• Calcific (Radiographic diagnosis)
• Others (Histopathologic diagnosis)
• III] PULP NECROSIS
ACCORDING TO F.J. HARTY
A simple classification based on the
state of the pulp.
◦ Normal pulp.
◦ Reversible pulpitis.
◦ Irreversible pulpitis.
◦ Pulp necrosis.
SHAFER’S Classification
1.According to involvement
a) Partial
b) Total
2. According to severity
a) Acute
b) Chronic
3. According to presence or absence of direct communication between the dental pulp
and oral environment
a) Pulpitis aperta
b) Pulpitis Clausa
5. According toWeine
A) INFLAMMATORY CHANGES
HYPERALGIA
Hypersensitive dentin.
Hyperemia.
PAINFUL PULPITIS
Acute pulpalgia (acute pulpitis)
Chronic pulpalgia (subacute pulpitis)
NON PAINFUL PULPITIS
Cronic Ulcerative Pulpitis
Chronic Pulpitis
Hyperplastic pulpitis.
B) ADDITIONAL PULP CHANGES
Necrosis
Retrogressive changes
Internal Resorption
According to Cohen:
Reversible pulpitis
Irreversible pulpitis
Asymptomatic Irreversible pulpitis
Symptomatic irreversible
Hyperplastic pulpitis
Internal resorption
Pulp necrosis
According to SELTZER (HISTOLOGIC CLASSIFICATION)
• Intact - uninflammed pulp
• Atrophic pulp
• Acute pulpitis
• Intact pulp with scattered chronic inflammatory cells (transitional stage)
• Chronic partial pulpitis
- with partial liqufeaction necrosis
-with partial coagulation necrosis
• Chronic total pulpitis
- with partial liqufeaction necrosis
• Total pulp necrosis
6. 1-Inflammatory diseases of the pulp
(Pulpitis)
❑ A- HYPERALGESIA- HYPERSENSITIVITY- REVERSIBLE PULPITIS HYPERSENSITIVE-DENTIN-HYPEREMIA-
HYPERACTVE PULPALGIA
❑ B – IRREVERSBLE PULPITIS
a) SYMPTOMATIC PULPITIS :PAINFUL PULPITIS: ACUTE PULPITIS
b) ASYMPTOMATIC PULPITIS: NON PAINFUL PULPITIS:
CHRONIC PULPITIS
✓ i.CHRONIC ULCERATIVE PULPITIS
✓ ii. CHRONIC HYPERPLASTIC PULPITIS
✓ iii. CLOSED FORM OF CHRONIC PULPITIS
7. Histopathology: Range from hyperaemia to mild to moderate
inflammatory changes limited to the are a of involved D.T., V.D.→
↑I.P.P. → Oedema → W.B.C.s infiltration →followed by odontoblast
differentiation and reparative dentin formation
Slowing of blood flow & hemoconcentration due to transudation
can cause thrombosis.
REVERSIBLE PULPITIS
A mild to moderate inflammatory condition of pulp caused by noxious stimuli in which pulp is capable of
returning to the uninflamed state following removal of the stimuli. Also, referred as “PULP HYPERAEMIA”.
A- Hypersensitivity- Reversible Pulpitis- Hypersensitive
Dentin-hyperemia- Hyperactve Pulpalgia
Focal Reversible Pulpitis
ETIOLOGY
1. Trauma
2. Thermal shock
3. Excessive dehydration
4. Galvanism
5. Chemical stimulus
6. Bacteria
7. Circulatory disturbances
8. Local vascular congestion
8.
9.
10.
11. Symptoms
Sharp pain lasting for a moment
More often brought on by cold than hot food
Does not occur spontaneously
Does not continue when stimulus has been
removed
Teeth are not tender on percussion
Teeth usually show deep caries, metallic
restoration with defective margins.
This will cause pain, in addition to inflammatory
mediators that will cause lowering of pain
threshold and the sensation of pain as a
result.(onset)
12. DIAGNOSIS
1. Pain: Sharp pain, lasts for a few seconds Cold, sweet or sour
causes pain
2. Visual examination & history:
Examine for caries, restorations, fractures or traumatic
occlusion
History of past dental treatment
3. Clinical tests:
Cold test is excellent way to locate pain
Normal to percussion, palpation and mobility
4. Radiographically : No changes
5. Vitality test:
More readily response to cold stimulation than
normal teeth Treatment
- Prevention
- Removal of the noxious stimuli
- Check for vitality
- Periodic care to prevent caries
- Proper insulation of the restoration
- Desensitization
Prognosis
Good - if irritant is removed earlier
Otherwise condition may develop to Irreversible pulpitis
13.
14.
15.
16. Irreversible Pulpitis
A persistent inflammatory condition of the pulp, symptomatic or asymptomatic, caused by noxious
stimulus.
❑ May be Acute or chronic
ETIOLOGY
Caries
Chemical, thermal and mechanical injuries
Sequelae of reversible pulpitis
B – Irreversble Pulpitis
Symptomatic Irreversble Pulpitis :
Painful Pulpitis: Acute Pulpitis
Definition: A clinical diagnosis based on subjective and objective findings indicating that
the vital inflamed pulp is incapable of healing.
17. Acute Pulpitis
Irreversible condition characterized by acute, intense inflammatory response in pulp.
CLINICAL FEATURES:
• Teeth extremely sensitive to thermal changes.
• Hot or cold stimuli cause increase in pain intensity & persists. As pulpal inflammation progresses, heat will
intensify the responses.
• Cold will tend to relieve the pain in advanced stages of pulpits.
• Pain can be spontaneous in nature which is sharp, piercing, intermittent or continuous in nature.
• Pain - poorly localized.
• lancinating or throbbing type. (10 – 15mins)
• Intensity of pain can increase when patient lies down.
HISTOLOGIC FEATURES:
• Edema in pulp with vasodilation.
• Destruction of odontoblasts at pulp dentin border.
• Rise in pressure due to inflammatory exudate local collapse of venous part of circulation Tissue hypoxia & anoxia
Destruction of pulp & abscess formation.
• Numerous abscess formation cause pulp liquefaction & necrosis. (acute suppurative pulpitis)
19. Irreversible Pulpitis: EARLY STAGE
•Sharp, severe pain upon thermal stimulation, especially cold
•Spontaneous or continuous pain
•Exacerbated by lying down
•Pain can be localized to a specific tooth.
Irreversible Pulpitis: LATE STAGE. S/s?
•Throbbing pain keeps patient awake at night; dull prolonged
pain
•Cold may produce relief; heat makes it worse
•Pain often referred - not localized
•Responds to percussion and palpation
•Radiographic periapical changes often evident
21. Diagnosis
• Deep cavity extending to the pulp.
• Decay under filling.
• Greyish scum like layer.
• An odor of decomposition.
• Probing into the area is not painful.
• Deep probing will result in pain & haemorrhage.
History-
-May reveal previous symptoms or a traumatic experience
Radiographic examination:
-May not show anything of significance.
-It may disclose an interproximal cavity or caries under a filling
Percussion:
-Tenderness
Pulpal pain is due to:
- pressure built up due to lack of exudate escape.
- pain producing substances from inflammation.
✓ Pain subsides when drainage is established or when pulp undergoes complete necrosis.
✓ The tooth is not tendered to percussion unless the pulpal inflammation has spread beyond the root apex into the periapical region.
22. POTENTIALLY REVERSIBLE PROBABLY IRREVERSIBLE
Pain Sharp, Momentary : dissipates readily after removal of
stimulus
Continuous, throbbing : Persists minutes to
hours
Stimulus Requires external stimulus
(cold, heat, sweet)
Spontaneous : dead or injured tissue in
chambers or canal.
Intermittent : Spontaneous pain of short
duration.
History Recent dental procedure, cervical abrasion Extensive restoration, pulp capping, deep caries,
trauma
Referred pain Negative Common
Lying down Negative Increases pain
Color Negative May be present due to tissue lysis & intrapulpal
haemorrhage.
Radiograph Restoration ,caries, periodontal pocket, cupping of
alveolar crest
Deep restoration, caries
Periapex - Normal Periapex – widening of PDL
Endodontic Therapy Franklin S. Wein 6th edition