Endodontics | Pulpal and Periapical Diagnoses | INBDE, ADAT

[@mentaldental]

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Hey i asked a question right now is the comment section please reply to it.

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Mental dental is not only helping students who are taking up INBDE , they are helping out a lot of students world wide. I have always admired their ability to make complex concepts seem extremely simple to understand.

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dental students in this generation are so lucky. there's no way they will fail the boards. God bless you mental dental!

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You're literally saving our dental online classes

[@ToothTalksHub]

Sir lot of love from an Indian BDS STUDENT... YOU'RE OUR INSPIRATION... THANKS FOR ALL SUCH WONDERFUL VIDEOS ❤️

[@sanjp9252]

Pulp and periappical diseases have always confused me no much, thank you so much for explaining it so well. loving all your lectures

[@primrose6294]

For pulpal diagnosis -Normal pulp -Reversible pulpitis -Symptomatic irreversible pulpitis -Asymptomatic irreversible pulpitis -Pulp necrosis -Previously treated pulp Thanks dr.

[@kevinclive4282]

Just a quick note to let you know that you are a legend and a HERO Ryan! Thank you for all of the work you put into these videos. You are awesome!

[@mentaldental]

Thank you so much for the kind words! 😊

[@Graphiclancers]

Me on google right now "How to thank your lecture who isn't your lecturer " Thank you soo much brother

[@mentaldental]

Haha, I appreciate it! 🙏🏼

[@2legit2hit]

These are explained so well and these similar sounding pathologies are simplified for high yield content. Really helpful. Thank you this!

[@Vivo119-jf4pp]

Got the chronic apical abscess this knowledge is here forever thank you

[@nnnnnnnn-b8v]

You are the best Sr. better than some University teachers i know.

[@brandonallen8926]

Our professors have given up teaching since the pandemic. You are saving us with these videos. Thanks!

[@alhussein5581]

Amazing as always my idol Can you show more clinical cases with every explanation of these ideas and thank you much❤️❤️

[@maryanneangala8485]

Thank you for this I had recently gotten hired as an endo assistant and I really need help charting clinical notes

[@rinkaldhillon3816]

Thank you so much. No other person had videos like you do.

[@anmoldixit8017]

Great video! I watch your videos even after clearing my boards , just to keep refining my concepts. Thanks Dr Ryan !

[@Abbas-88]

I read the source and i came here to take the review from u u are amazing 🥳💙

[@Trigemind]

Thank you so much, dr.Ryan! So much help and I really do hope you continue this!

[@mentaldental]

Great to hear! There will be more to come for sure :)

[@ysk249]

Thank you for posting a great lecture. Please add 'previously initiated,' ' previously treated' to pulpal diagnosis, and 'condensing osteitis' to periapical diagnosis.

[@doc1986ful]

Thank you Dr. Ryan!!! You are amazing!!!

[@gurleenkaur2583]

It is such an amazing video to understand these important term. thank you so much Dr.Ryan.

[@mentaldental]

You're very welcome!

[@miz0o096]

Can I say something your explanation is somthing else our doctors cand explan like you thank you for this video

[@kukusharma1191]

You r God of explanation Ryaan Tysm Love from India💛

[@childrenofgod3015]

You are a true blessing to many.. may Lord Jesus continue u to bless many many young minds to learn and do well in this field in Jesus name amen 🙏 ✝️💯

[@mentaldental]

Amen! 🙏💯

[@Trigemind]

Very clear and wonderful explanation!😍

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Grateful for this channel love your videos! Words arent enough for how thankful i am keep up the good work🙏

[@mentaldental]

Thank you for the kind words! 😊

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Thank you so much, Dr Ryan! 🌸

[@aslburcindemir3301]

Thank u so much! It’s very helpful for school. I’m grateful to u💛🦷

[@annacanta5659]

Thanks so much Ryan! So helpful! Love learning from your vids!

[@amribrahim1486]

thank you dr. very helpful

[@lora7677]

Thank you so much! I am learning a lot from you!

[@mentaldental]

That’s wonderful! You’re welcome 😊

[@MM-kq8gc]

highly informative video! please keep uploading these excellent videos!

[@dr.rashaal-edilbi5126]

thank you so much Doctor, well explained

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Thanks doctor Love from Iraq❤️

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Thank you so much. It`s really useful!

[@hammeed4878]

Thank you doctor for the awesome videos!

[@cdds113]

Great explanation!

[@alaanaeem1989]

thanks, sir for your help

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Thank you very much for this video😊😊

[@mentaldental]

You’re very welcome! 😊

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Thank you very much

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Thanks so much doc Your the best

[@goodyhassan7587]

thanks a lot of this amazing information❤❤❤❤❤❤❤❤

[@dentalmitra7864]

Thanks for uploading! Very educative ! Valuable topic .

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You are awesome ❣️

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Amazing!

[@dr.sumaya3122]

Thanx alottttt❤️ it was very helpful video ❤️❤️

[@TheSANATmethod]

Thank you.

[@mentaldental]

You're welcome!

[@mostafasayed7816]

impressive you are the best

[@Mamiiaa]

Hello, thank you for this helpful video. I have a question: how can we differentiate clinically between a sound pulp state and an asymptomatic irreversible pulpits?

[@mentaldental]

That's a great question! It would mostly be from taking a thorough dental history for the patient, and finding that there is something that has contributed to irreversible pulpal damage like trauma or deep caries (which you would likely see clinically and radiographically).

[@thilleliavehri1219]

@@mentaldental Thank you for your reponse! ^^

[@aristarchussmeda]

Very helpful thx a lot

[@mahgulwahab5301]

I love you ryan

[@niooshashadi]

Hey dr. Thanks for u video really helpful . Could u plz let me know what is least effective irrigation against E.facialis? Options are : chlorhexidine - hypo - tetracuycline - iodine

[@NetflixPlusMovies]

How can we diagnose and treat an IRREVERSIBLE PULPITIS? Cause Bacteria from the oral cavity pass through a defect (crack, caries or leaking restoration) and gain access to the pulp chamber. The pulp mounts an inflammatory response and defends the pulp chamber from the organisms. Unfortunately the increased pulpal pressure makes the A delta fibres fire at a lower threshold. Meaning the patient gets extreme sensitivity to hot liquids(but often cold liquids also are severely sensitive and rarely can even be calming for the inflammation.) Diagnosis. Elicit the pain using thermal tests! Hot can be done using dam and hot water. Cold tests can be done using Endo frost and a cotton pellet or CO2 snow (more difficult to obtain). Often these teeth exhibit minimal if not periapical radiolucency because the disease has not been present long enough to show significant inflammation. Treatment. The pulps of these teeth tend to be large as the bacterial infiltration tends to be rapid, allowing little or no time for calcification. So anaesthesia is the challenge - location and preparation of the canals per se aren’t normally a problem! For lower molar teeth I have used 2.2ml Articaine for mandibular for many years with success. A buccal infiltration of 2.2ml articaine and then a lingual infiltration using 2.2ml lignocaine. WAIT 10 mins by the clock and then re-test using thermal testing to check before you start performing access.. this does a couple of things 1. Firstly shows you are using something to assess before using a drill and therefore are being nice to the patient but also 2. Allowing them to indicate that they feel comfortable enough for you to begin access. “Can you feel the cold? “No, I don’t feel this anymore.” - this is a good indication they are happy to begin !! Access and then removal of the pulp tissue is required. Usually just the coronal pulp removal is required to give relief (but I try and remove all the pulp to the apex). Placement of steroid antibiotic paste is helpful if you haven’t removed all the pulp. Or calcium hyd if you have removed it all. Then sealing of the defect using a temporary restoration will prevent leakage. And remove symptoms! Don’t forget to adjust the bite. If you are doing NO Drill dentistry at the moment 4mg dexamethasone has been used before my some clinicians with success.

[@Digifan77]

Pls do slides on how to interpret information via opg and iopa. Thankyou

[@lifeofhope5100]

Super video

[@peggy6856]

Thank you for the videos! In the case of Asymptomatic Irreversible Pulpitis, how can we diagnos the patient when they have no symptoms and the x-ray is of no help?

[@mentaldental]

You can’t! You need a good radiograph to diagnose that condition.

[@عليسالم-ل7ن]

Great job ,, can i ask question,, what the best material for dirict pulp cap MTA or Ca hydroxide ??

[@abegail6580]

Microbiology in Endodontics pls thanks

[@priyaramesh1666]

Thank u dr.ryan.

[@sushumakollata]

You are amazing........

[@bhargavi368]

Dr. Rayn thank u so much!! 👌👌 Doc I have a query even cold test is also a pulp sensitivity test and not a vitality test... But you everyone says it's better than thermal and EPT And how does it differ from them Pls can u help me with this doc🥺

[@dmi3293]

❤️❤️❤️❤️❤️❤️❤️thnx dr

[@ADwina-ku3fl]

thank you

[@aboudaboudi8092]

Nice good job ,👍

[@jackelineescalante2065]

Hello Dr Ryan. Thank you so much for you videos!!!! I want to know if there's any difference between condensing osteitis and idiopathic osteosclerosis, I hope you can see this comment!!. Thank you.

[@mentaldental]

Condensing osteitis is a localized diffuse radiopacity as an inflammatory response of bone usually to a tooth infection--and is usually located around the apex of the infected tooth. Idiopathic osteosclerosis can LOOK the same, but is not necessarily around the apex of a tooth and is not usually associated with inflammation.

[@angelicafoster670]

what fibers are involved in - reversible pulpitis - irreversible pulpitis

[@drjiss]

What is the hallmark of asymptomatic apical periodontitis.?

[@katrinawannesian2233]

Super🥇

[@arash_LA]

you're saving my a... in dental school. :-)

[@springsh6678]

Hey Dr Rayan question about Asymptomatic Irreversible Pulpitis, How we can decide to proceed with Endodontics treatment if pt has irreversible pulpits but is responding to tests in a normal way? do we have to rely on clinical findings such as advanced caries or pulp exposure to some extent to the oral cavity environment? because at this stage radiography won't be that much of help tho. Thanks

[@Drbrijesh_dental_clinic]

same question, i also have ? i think there is delayed response to cold test or EPT..

[@saram8079]

Hi dr I want to ask you about the lingering, i just don’t understand what it’s mean in dentistry?

[@mahsaman2011]

Thank you so much Dr. Ryan. How can we have the slides from your videos? also do you have them in Quizlet?

[@mentaldental]

You can get the slides one of two ways. You can either sign up on my Patreon page www.patreon.com/mentaldental or send $30 to me directly via PayPal www.paypal.me/mentaldental I do not have them on Quizlet, though I love that platform as a study tool.

[@mahsaman2011]

@@mentaldental Thank you

[@DrKomalSBorana]

Very useful video Thank you so much Sir😊

[@fashionlovers7749]

Plz also upload mscqs of these topics ...

[@springsh6678]

Hi Rayan thanks again for your really helpful series I just need to know what if patient is chewing on an ice and it makes the pain goes away I heard from another lecture this is a sign for none reversible pulpitis as due to inflammation there is a pain but putting cold on tooth will ease off that inflammation is that correct?

[@urvimehta9717]

Hey Dr. Ryan, thanks for the wonderful video. I had a question regarding EPT. Is it contraindicated in recently erupted primary teeth?

[@mentaldental]

Vitality testing in general is not useful for primary teeth. From Gopakumar et al: “Electric pulp testing has shown to be unreliable or rather non effective in deciduous teeth and immature permanent teeth because the relationship between odontoblasts and nerve fibers of the pulp has yet to develop.”

[@urvimehta9717]

@@mentaldental thank you for the detailed explanation

[@batoo_l5277]

Thank you very much, how can I get the pdf?

[@mentaldental]

You can get the slides via two options, PayPal or Patreon! Visit www.mentaldental.com/faq for more info 😊

[@dr.benijaminkozica5703]

If the response on cold stimuli for a ireversible asimptomatic pulpitis is equal to normal pulp , how u are going to distinguishe between those two diagnoses ?

[@mentaldental]

Great question! The cold test alone would generally not give you enough information in this case. You would need to add other clinical tests in addition to discussing the patient's history of their dental problem.

[@shifaraza6658]

What causes the asymptomatic apical periodontitis to be asymptomatic even thought the infection is present in the periodontal tissue showing the radiolusency ?

[@mentaldental]

It’s the same concept as asymptomatic periodontitis when it is asymptomatic even though infection is present in the periodontium. It’s because most pain is the result of pressure, and if there is no pressure build up (like would happen if there is a draining sinus tract for example) then the patient likely won’t feel pain.

[@musabrustom]

thx for your effort but how come that the tooth is vital and has sympt. apical periodontitis and you said perviously that it's an extension of necrotic pulp

[@doctoranwar3667]

Musaab Rustom in cases of periendo lesion....where source of irritant is not from pulp but from periapical tissues

[@misssudanese138]

Can u please tell me when I have 2 do xray if the tooth is carious??? Follow from sudan

[@GabriellaGodessa]

where can i find the internal bleaching video please?

[@mentaldental]

Here is the link to it: kzbin.info/www/bejne/kImanJyilpZ_r5Y

[@gravijiga]

I have been having tooth pain that lasts about 10-20 minutes from slight pressure. It's on a tooth that has recently has a deep restoration. My tooth was fine for about 3 weeks then due to some pressure and I started having these longer 15 minutes tooth aches about once a day since then. (About 5 days now) my dentist did some X-rays and said I seem fine and to stay off the tooth for a few weeks. Is it possible to recover or does the pulp become more and more damaged with each ache?

[@mentaldental]

Thanks for your question. I can't say for sure without a clinical evaluation and a look at your x-rays myself, but it sounds like you are describing a restoration that may be high in occlusion. Did the dentist smooth out the restoration a bit so you're not biting so hard on it?

[@gravijiga]

Yes. I went back in a few days later to have it smoothed a bit. After that it was fine for two weeks until I aggravated it by wobbling it a bit (it's been wobbly for years) since I posted I my first comment I had gone to another dentist for a second opinion and she said the same thing. She tapped it, got my to bite down and blew air on it with no negitive response.

[@sharanshah5446]

Can symptomatic apical periodontitis show any radio graphic changes? Pls help

[@mentaldental]

Yes, it is very possible to see a periapical radiolucency associated with symptomatic apical periodontitis.

[@somiahassan5758]

i have question if any one can help me to understand ( why symptomatic irreversible pulpitits radiographs is generally insuffiecient)

[@drjiss]

Plz reply for ma question I have prometric exam on 8th

[@minamoheb9793]

Thank you where is the PDF ?

[@ayeshasaleem7459]

Dr. What is pheonix abcess?

[@surya-wc4cb]

Acute exacerbation of chronic periapical abscess

[@michalukasz1660]

4:24 "if cardiac pacemaker" if cardiac pacemaker what?

[@paridhitiwari423]

Same doubt ...

[@mentaldental]

An EPT is contraindicated in a patient with a cardiac pacemaker due to potential electrical interferences.

[@michalukasz1660]

@@mentaldental To those who do not know nor understand, such electrical devices can also affect the biological pacemaker, in people who do not have artificialy implanted pacemaker apparatus due to affecting the hearts natural electrical axis. This phenomena pertains also to all of the electrical root length testing devices, which require a circuit to be formed -they can alter the hearts functioning and the so called electrical axis causing arrythmia. Also the usage of larger doses of adrenaline in anasthetics containing vasoconstrictors can cause cardiac impairment. In addition if applied to inflamed or abscessed areas, were the diffusion into the blood is greater therein various anasthetics can be very unhealthy to potentialy normal hearts and their functioning.

[@harpreetrandhawa8958]

In diagnosis of chronic apical abscess vs chronic periodontal abscess is it EPT or Thermal test IF anybody from mental dental could please help

[@mentaldental]

Hi Harpreet! Technically, either would suffice. For a chronic apical abscess, the tooth is most likely dead so the tests would read that the pulp is necrotic. For a periodontal abscess, the tooth will often be alive so the tests would read that the pulp is vital. I would first do a cold test myself.

[@rinkaldhillon3816]

What is the cause of having a sinus tract after 3 months of endo treatment. No pain at all since the RCT is done..

[@minamoheb9793]

Is it normal to be pain on percussion (sap) after RCT ( the day after RCT up to a week) in some cases and may extend to a year in other cases ...cause and ttt please ?? Thanks

[@mentaldental]

Absolutely! Persistent pain following RCT is defined in the literature as pain reported up to 6 months following removal of the pulpal tissue that the patient localizes to his/her dental-alveolar structures. Current studies report about 10% of patients experience this. It is far more common to have pain and/or sensitivity for a few days or weeks after treatment.

[@iclipatates8614]

Thank you

[@mamabear8591]

Thank you