Video 4 - Diagnóstico Pulpar

Hi everyone, how are you? Today we are going to talk in respect to the pulp Before properly talking about the pulp diagnostics I would like to talk a little in respect to the biology of the pulp The biology of the pathological events that will lead to pulpitis and finally pulp necrosis Let’s go? So let’s start by remembering the following: Three things aggravate the pulp Caries Trauma and the dentist. You think it’s funny that I said “dentist” You were waiting for me to say iatrogenesis. No, it is actually “dentist” that I wanted to say Because, honestly,

iatrogenesis, is a beautiful word to substitute an ugly one When a dentist goes and does something that isn’t really correct, We all say that the doctor committed another iatrogenesis To avoid saying the the doctor did a **** to your tooth No, I want to say that it’s actually the dentist that aggravates the pulp And iatrogenesis even more Why? Imagine a normal situation you are doing a shallow resin cavity restoration very shallow plenty of water spray, for everything to be correct In this case, is there something wrong? No, there is nothing wrong You are not committing

an iatrogenesis Right? But you are aggravating the pulp Just the fact that the pen is in contact with the dentin spinning and cutting, even if it is very cold the pulp is being aggravated So, what aggravates the pulp is not only iatrogenesis Even the most accurately done procedure will also aggravate the pulp Of the three factors, the most aggressive is caries More than 90% of the endodontic treatments have to be performed due to dental caries This is not because of the intensity of the aggression but due to the the duration The bacteria stays for an

undetermined time in the carious lesion and doesn’t leave until someone takes it out While the bacteria is in the carious lesion, it produces toxins These toxins go through the dentinal tubules and reach the pulp continuously aggravating it And how does that reflect in the severity of the symptoms that the patient experiences during Pulpitis? To understand this, we have to remember the pulpar anatomical situation the fibers and vessels that arrive there The pulp is a connective tissue therefore vascularized with many nerves, but with a very specific anatomical characteristic It is found completely surrounded by hard tissue

The pulp is always in a normal situation where it is completely surrounded by the dentin walls Which are hard rigid and don’t expand And it is because of this, during an inflammatory process, there is no way for the pulp to swell In any other bodily tissue, immediately when the body suffers an aggression an inflammatory process is initiated, and we can see that this tissue swells It looks like an edema and grows And there is no way for this to happen with the pulp The inflammatory process can happen in one of the three processes that I

mentioned Caries trauma or the dentist I’m going to stick more to the the biological process caries because it is the most common In this case, a colony of bacteria will stay housed next to the pulp initially, without contact with it However, the bacteria produce a series of toxins at the same time that they destroy the dentin and the caries grows Part of the constitution of the dentin aside from collagen and hydroxyapatite Is a set of very important proteins called bioactive molecules or growth factors I will highlight one of them There is a bioactive molecule called

TGF beta that is part of the constitution of dentin When the dentin is destroyed the TGF beta is released it falls into the dentin tubules and reaches the prolongation of the odontoblast The odontoblast is in the most peripheral layer of the pulp and makes contact with TGF beta for the first time What is the reaction of the odontoblast when the TGF beta arrives in it? It realizes that there is something wrong and initially begins to mineralize the tubules and produce a harder dentin Then it tries to produce an extra layer of dentin in the pulp

and flees to the pulp As the caries evolves the odontoblast will take all these steps Only if nothing is done, the caries will continue to progress and none of this is going to help it Ultimately the inflammatory process is so intense that the odontoblast will die In this case what do we have? An inflammatory process that is only increasing An inflammatory process that is only increasing mainly characterized by the increase of blood at the site For us to have more blood we need to have vasodilation So, the blood arteries of the pulp will dilate more

and more to bring more blood to that place of aggression We have a deep carie very close to the pulp but often without yet exposing the pulp A very intense inflammatory process with the arrival of blood increasing each time This blood coming up to the pulp chamber where is it coming from? To get there blood comes from an arteriole that will penetrate the apical foramen Which is a rigid, hard hole, in the root apex And this apical foramen penetrates aside from this arteriole a very fine vein to bring the blood back and at least one

nerve bundle So, in a normal situation, these three "people" pass through this little place It is only in the case of a very intense inflammatory process that the arteriole grows well beyond normal occupies an entire foramen crushes and squeezes venola against the wall of the foramen It also tightens the nerve bundle against the wall of the foramen and an irreversible process is set in motion The blood arrives but can not return because the vein is completely pressed against the wall of the apical foramen This is chaos from the tissue’s point of view In the pulp

chamber, the blood that is arriving and has nowhere to go ends up spilling out of the blood vessels and initiating a coagulation process The pain at that moment is unbearable because we have an inflammatory process with a neurovascular bundle being pressed We have an inflammatory process in which we begin to lack oxygenation because we do not have a renewal of blood tissue The blood arrives and there is no way to leave So, the evolution of this process will ultimately lead to tissue necrosis Without oxygenation, the cells begin to die A process of pulp degradation begins

in the region next to the caries and it evolves from the pulp chamber toward the apex until the complete tissue necrosis So hopefully you can understand more or less how the process of pulpal inflammation evolves and why it culminates in tissue necrosis The next video we will connect these biological phenomena with the diagnosis of pulp itself with the pulpitis, reversible and irreversible, and necrosis We are going to study exactly what the patient feels If you liked the video you can “like” it and subscribe to our channel Bye