Endodontics Overview

Introduction

• Focus on endodontics for dental board exams.
• 31 questions out of 500 on the dental board exams.
• Videos geared for exam preparation and clinical application.

Biology of the Dental Pulp

• Pulp Importance: Innermost part of the tooth, soft and vascular.
• Components:
  • Loose fibrous connective tissue with nerves, blood vessels, and lymphatics.
  • Contains fibroblasts (secrete fibrous connective tissue).
  • Odontoblasts (secrete both primary and secondary dentin).
  • Undifferentiated mesenchymal cells (can become secondary odontoblasts).
  • Surrounded by hard dentin limiting expansion and infection response.

Pulp and Dentin Defense

• Sclerotic Dentin: Hard dentin responding to slowly advancing caries or aging.
• Reactionary Dentin: Reaction to minor damage.
• Reparative Dentin: Repair for major damage, formed by secondary odontoblasts.
• Pulp Capping: Technique using calcium hydroxide liner to form reactionary or reparative dentin.
• Pulp Necrosis: Tooth death due to rapid caries or severe damage.

Causes of Pulpal Injury

• Major cause: Bacteria from dental caries or cavities.

Histology of Dental Pulp

• Layers from Outside to Inside:
  • Dentin (dark layer).
  • Predentin (lighter, unmineralized).
  • Odontoblastic layer (nuclei of odontoblasts).
  • Cell-free zone (Zone of Weil).
  • Cell-rich zone (many nuclei).
  • Pulp core (central part).

Types of Pain

• Dentinal Pain:
  • Conducted by A-delta fibers (large, myelinated, afferent).
  • Sharp, transient pain associated with cold.
  • Fibers course coronally.
• Pulpitis Pain:
  • Conducted by C fibers (small, unmyelinated, afferent).
  • Dull, throbbing pain associated with heat.
  • Fibers course centrally.

Pain Sensitization

• Hyperalgesia: Heightened response to pain.
• Allodynia: Reduced pain threshold, pain from non-painful stimuli (e.g. sunburn).

Referred Pain

• Preauricular Pain:
  • Often refers from mandibular molars sharing V3 innervation.
  • Important in understanding dental innervation maps.

Conclusion

• Importance of understanding pain transmission in endodontics.
• Encouragement to subscribe for more content on dentistry.