I've watched your videos in dental school and I was amazed at your teaching, and now that I'm a dentist, I still find myself coming back to your videos for a reminder of what I see clinically in patients. Great explanations, glad to have access to this information just at my fingertips. You are easy to follow and yet go into a lot of detail. Perfect for any dentist to watch. Thanks.
Thank you for the kind words. Motivation for making more like this. In fact, I'll make a video on apical pathology which I will hopefully share next week. Best wishes! :)
D4 here! Giving the application cycle as many tries as necessary to become an endodontist! I just want to say diving through all your videos has been such a gem of a resource for my learning and foundation!
May God bless you Dr Nasseh... I can't tell how much this means to me. You do justice to your channels name. I will never forget a word of this lecture because you so beautifully correlated theories to the real Endodontic practice... This is real world Endo. Bless you.
Fundamental yet pragmatic Demonstration. Dr. Nasseh is blessed with striking eloquence! Quite salient a correspondence between Name [nasseh=adviser] and Attribute [rhetoric]
i always asked the question why cold application can reduce the pain in pulpitis when its the primary cause of pain in all patients and now I finally know the answer . thank you dr ali I look forward to videos like this one .
Thank you Dr. Nasseh. Not only do I enjoy your lectures and clinical demonstrations, I have already put some of what I learned from you into practice. Thank you!
That's not enough info. You need history of present illness, chief complaint, and other clinical radiographic data to make a decision. Without that it makes no sense to propose anything. So, what's next is gathering more clinical and radiographic data. However, it sounds like it will likely be irreversible pulpitis.
Thank you very much for posting this. How can we tell if the inflammetion is confined to coronal pulp or has reached the radicular pulp clinically to do whether pulpotomy or pulpectomy as an emergency treatment? Best
Currently you can’t tell for sure. You can use the bleeding time and whether the pulp stomp coagulates within 2-5min as a proxy for it not being infected. It’s not a clear science but it’s what we have for now… until we come up with a potential chair-side biological marker to use for this measurement. Cheers.
A great lecture doctor I have some questions 1- where does the fluid go when it leaves the conical dentinal tubule ? Does it reach enamel and then exits the tooth and how ? 2- when we cut the dentin doesn’t that make the tubule wider as it is conical in shape ? So doesn’t that allow more fluid to go through? So that will trigger pain ? And still now where does that fluid go as we use the bonding agent that goes inside of the tubule 3- isn’t there a nerve inside the tubule so isn’t cutting the dentinal tubule going to cause a permanent injury to the nerve and the odontoblast that has a process inside the tubule so this contradicts with the principle of conservative fillings 4- what about lateral canals does this apply to it too ? 5- what is the fluid that goes through the dentinal tubules made of ? Sorry if i had so many questions and i hope you answer all. Thank you 🙏
@@AANasseh Was in general looking at how teratoma ability to parasitically harness body's stem cell power to grow its own teeth could be better understood and used for regrowing teeth in humans in the future - somehow ended up watching your video - it made me think how precious this pulp is, how precious milk teeth and wisdom teeth could be in dentistry. in general your presentation style is very interesting. and this remark about how pulp can't increase in volume - otherwise pain - that's why I rinse with geranium essential oil with water and coconut oil as prevention. Have a wonderful year! thanks for all you do:)
@@cheerstopoland Yeah... lots of totipotent stem cells in and around the pulp, especially in the dental follicle of developing roots. Those cells could be harvested to regenerate the pulp. The main problem for this premise is not the pulps regenerative capacity, which is a given, but our inability to completely sterilize the inside of the tooth, which would be a required step before pulp can regenerate predictably. The main limitation is the complexity of the system and our inabilty to sterilize it, which is why we fill root canals instead of leaving them open. This way we entomb and eliminate the grown of any bacteria. Cheers!
I appreciate Dr. Nasseh's review of the pulp and its complex. However, Dr. Nasseh mentioned that a rise in pressure causes wide spread effects in the pulp and this has been implied as unlikely(Tonder and Kvinnsland, 1983). A change in localized pulpal pressure does not appear to spread throughout the pulp or effect the venous beds at the base of the pulp when measured in vivo, and thus strangulation of the pulp is unlikely. Other than this very minor point I thought this was an excellent review. Thanks.
well i have understood about nerve supply would u explain me about hyperemia and its sequele in pulpal irritation ?. by the way ur clarity on the subject is awesome. tthank you somuch dr.
what about pain to "sweets" some pts claim that it occurs spontaneously after eating... what's the mechanism behind that or is just dentinal hypersensitivity? massive fan and student of yours from Iraq!
Good question! Current theory is that sweets is causes an osmotic gradient across the dental tubules moving fluids out and causing pain. Also, within 30 seconds of introducing sweets in the mouth the pH drops down below 5.5 in the oral cavity. So, sweets also activate the microbes in the caries to release acid that further irritates the pulp. So, that's from the sharp and quick sweet reaction to osmotic pressure all the way to long lasting pain which is acid from a carious lesion. Hope his helps! :)
If the sensitivity during biting wasn't caused by any suspicious crack, so happen there was a composite filling just did by someone not long ago. What would be the sequence of examination to ascertain if there is a chance of debonding? Appreciate your guidance!
That's fairly common actually. The main reason is a lack of proper seal in some areas of the composite. You also have to see whether the sensitivity is due to biting, which is likely due to cuspal deflection due to improper bonding, or merely cold sensitivity or if you're running an explorer on the tooth causing sensitivity. Those are all poor bonding technique and allowing for small areas where no bonding is present on the surface of etched dentin, causing fluid movement in the tubules. All those can generally be resolved if you remove the entire composite and replace it with a sedative filing and observe the symptoms. If they improve, go back to a new, better sealing composite. If they don't, then endo may be required.
Informative Reversible pulpitis why dull pain non continous intermittent in character... Tou told that a fibres are situated periphery... If the caries reaches near to pulp most of the patient will have dull pain less intensity Whats the reason for that
If the caries reaches the pulp it's generally considered irreversible pulpitis. The dull ache is the spontaneous component of pain, which is generally from the pulp proper (c-fibers). They feel the A-fibers whenever they have something cold given their decay! (sharp shooting pain!)
I just want to ask any dentists out there- is it normal to open and drill dentin out then remove some abscess from roots and not finish root canal fully and just close it? Thats what my dentist did and i feel pain whenever my treated tooth touches the tooth in the bottom.. he said he cant finish the root canal due to covid 19. The treated tooth also has a minor crack, so im worried it will just break although im being really careful not to put any stress on it. Any advice would be appreciated.
Doc could you please explain why we need to de-occlude after endodontic treatment or is it really necessary??? because patients complain of POP a lot of times if the RCT procedure is planned for 2-3 seatings thankyou
Not sure what you mean by de-occlude... do you mean remove the smear layer or to achieve patency through apex? Most cases can be done in a single visit if you understand the underlying principles of success and your efficient enough in applying the required protocol for success. Cheers!
Yes, it's more common than one would think. In about 7% of the population, the cementum doesn't cover the root around the CEJ. In canine teeth and some other anterior teeth, this can cause infection through these tubules that along with possible cases of ortho or trauma, can cause necrosis. Sometimes these teeth are necrotic but asymptomatic. Other times, they can become symptomatic. But over all, it's very possible to have necrosis in what appears to be a virgin tooth. It's very important to do proper vitality tests with cold (comparing to the contralateral side) as well as EPT to make sure before cutting into the tooth. Cheers!
Dr. Nasseh...I have one question Is it true that after root canal therapy the tooth is actually not dead because it still has blood supply from periodontal ligament? Please throw some light on it considering my question... Love from India...
I've watched your videos in dental school and I was amazed at your teaching, and now that I'm a dentist, I still find myself coming back to your videos for a reminder of what I see clinically in patients. Great explanations, glad to have access to this information just at my fingertips. You are easy to follow and yet go into a lot of detail. Perfect for any dentist to watch. Thanks.
Thank you for the kind words. Motivation for making more like this. In fact, I'll make a video on apical pathology which I will hopefully share next week. Best wishes! :)
D4 here! Giving the application cycle as many tries as necessary to become an endodontist! I just want to say diving through all your videos has been such a gem of a resource for my learning and foundation!
@@NickGagliano-g2s apply and keep applying ! Don’t give up. You’ll get there. 👍
May God bless you Dr Nasseh... I can't tell how much this means to me. You do justice to your channels name. I will never forget a word of this lecture because you so beautifully correlated theories to the real Endodontic practice... This is real world Endo. Bless you.
That was immensely informative, thank you dear endodontist for making dentistry a little better.
Thanks for the simple but yet exceptional explanation, also thanks for taking the time to share your knowledge with all of us.
Fundamental yet pragmatic Demonstration.
Dr. Nasseh is blessed with striking eloquence! Quite salient a correspondence between Name [nasseh=adviser] and Attribute [rhetoric]
This video was very very helpful for my endodontic residency exam , I am very grateful for your videos and clinic tips , love it 👍👍👍😁😁😁
i always asked the question why cold application can reduce the pain in pulpitis when its the primary cause of pain in all patients and now I finally know the answer . thank you dr ali I look forward to videos like this one .
I love the way you teach Endodontics... here, a new follower and learner, from Chile
way better explanation than in dental school.
Every sec of the video was educational ... Much appreciation Dr. thank you
That was in one word an AMAZING lecture. never understood this concept as simple as this one. Thank you so much doctor.
Fantastic explanation! I never understood the dental pulp and diagnosis in this way
Thank you so much for the clarity of presentation and the generosity! Super helpful- you are an amazing teacher.
I know I'm late but great video thx a ton!! It's amazing how complex our bodies are down to the tooth
Thank you Dr. Nasseh! I really enjoy your videos as a dental student. Thank you for your work.
Thank you!
Thank you Dr. Nasseh. Not only do I enjoy your lectures and clinical demonstrations, I have already put some of what I learned from you into practice. Thank you!
patients shows no response to cold and EPT test.and heat test shows positive test .then sir wat is the treatment plan ???
That's not enough info. You need history of present illness, chief complaint, and other clinical radiographic data to make a decision. Without that it makes no sense to propose anything. So, what's next is gathering more clinical and radiographic data. However, it sounds like it will likely be irreversible pulpitis.
OK thank u so much sir .
Wonderful explanation associated with clinical tips👍👍
I learned so much here. Pefsonally I will be taking Advil after every deep dental filling from now on to reduce inflammation
Thank you very much for posting this.
How can we tell if the inflammetion is confined to coronal pulp or has reached the radicular pulp clinically to do whether pulpotomy or pulpectomy as an emergency treatment?
Best
Currently you can’t tell for sure. You can use the bleeding time and whether the pulp stomp coagulates within 2-5min as a proxy for it not being infected. It’s not a clear science but it’s what we have for now… until we come up with a potential chair-side biological marker to use for this measurement. Cheers.
Extremely good way of teaching !
I just became so much clearer on the pain mechanism. Thank you doc.😊
This video is amazing in its explanation. Thank you.
Wonderful video, thank you!!
Gratitude beyond limits..
Very Informative, nice simplification of the subject. Thank you
Great way to teach such complex subject thanks doc
Thank you, Nice job explaining the pulp process.
thank you doctor Nasseh.Yor work is very interesting and helpfull.i enjoy it.
Excellent review
Merci
Thank you sir. It's a very helpful video. The histo-clinical correlations where very interesting.
Amazing video thank you
Great lecture.
Thank you for the concise and helpful lecture!!
A great lecture doctor
I have some questions
1- where does the fluid go when it leaves the conical dentinal tubule ? Does it reach enamel and then exits the tooth and how ?
2- when we cut the dentin doesn’t that make the tubule wider as it is conical in shape ? So doesn’t that allow more fluid to go through? So that will trigger pain ? And still now where does that fluid go as we use the bonding agent that goes inside of the tubule
3- isn’t there a nerve inside the tubule so isn’t cutting the dentinal tubule going to cause a permanent injury to the nerve and the odontoblast that has a process inside the tubule so this contradicts with the principle of conservative fillings
4- what about lateral canals does this apply to it too ?
5- what is the fluid that goes through the dentinal tubules made of ?
Sorry if i had so many questions and i hope you answer all. Thank you 🙏
Thanks aloootttt soo usssseful
Please more lectures
wow I have nothing to do with dentistry but I watched it with such interest... great presentation
LOL!! How did you even end up on this page?!!! Happy New Year!
@@AANasseh Was in general looking at how teratoma ability to parasitically harness body's stem cell power to grow its own teeth could be better understood and used for regrowing teeth in humans in the future - somehow ended up watching your video - it made me think how precious this pulp is, how precious milk teeth and wisdom teeth could be in dentistry. in general your presentation style is very interesting. and this remark about how pulp can't increase in volume - otherwise pain - that's why I rinse with geranium essential oil with water and coconut oil as prevention. Have a wonderful year! thanks for all you do:)
@@cheerstopoland Yeah... lots of totipotent stem cells in and around the pulp, especially in the dental follicle of developing roots. Those cells could be harvested to regenerate the pulp. The main problem for this premise is not the pulps regenerative capacity, which is a given, but our inability to completely sterilize the inside of the tooth, which would be a required step before pulp can regenerate predictably. The main limitation is the complexity of the system and our inabilty to sterilize it, which is why we fill root canals instead of leaving them open. This way we entomb and eliminate the grown of any bacteria. Cheers!
Ty. Sir..... great info......clear most of the doubts......
congrats, the explanation was very clear,
Beautiful explanation! thank you so much!
Thx fr your lecture, doc.
I appreciate Dr. Nasseh's review of the pulp and its complex. However, Dr. Nasseh mentioned that a rise in pressure causes wide spread effects in the pulp and this has been implied as unlikely(Tonder and Kvinnsland, 1983). A change in localized pulpal pressure does not appear to spread throughout the pulp or effect the venous beds at the base of the pulp when measured in vivo, and thus strangulation of the pulp is unlikely. Other than this very minor point I thought this was an excellent review. Thanks.
AWESOME video. Very helpful. THANK YOU!
Excelente docente, muchas gracias!
well explained dr naseeh thank u
Thankyou so much doc!
Always good learning
Thank you for this great review.
Thank you for this informative lecture
from a dental student myself, I thank you!!!!
I also love the fact you include "clinically" relevant information. Please continue to spread your wise knowledge!
well i have understood about nerve supply would u explain me about hyperemia and its sequele in pulpal irritation ?. by the way ur clarity on the subject is awesome. tthank you somuch dr.
It was great Sir Ali
Thank You dr..very appreciated work
You are amazing!!!! Thank you so much:)
Thank you very much , great lecture!
Merci Dr.Nasseh.
what about pain to "sweets"
some pts claim that it occurs spontaneously after eating...
what's the mechanism behind that or is just dentinal hypersensitivity?
massive fan and student of yours from Iraq!
Good question! Current theory is that sweets is causes an osmotic gradient across the dental tubules moving fluids out and causing pain. Also, within 30 seconds of introducing sweets in the mouth the pH drops down below 5.5 in the oral cavity. So, sweets also activate the microbes in the caries to release acid that further irritates the pulp. So, that's from the sharp and quick sweet reaction to osmotic pressure all the way to long lasting pain which is acid from a carious lesion. Hope his helps! :)
Thank you ,DrNasseh :D
just learned a new word thanks to you :D
permeable
permeable
permeable
permeable
permeable
permeable
permeable
perfect 😍 thank you 🙏🏻
yeahh !!! this remided me about college ..man ... very nice and on point explanation :)
how to diagnose radiographically cyst and granuloma and apical abscess and the treatment also.
If the sensitivity during biting wasn't caused by any suspicious crack, so happen there was a composite filling just did by someone not long ago. What would be the sequence of examination to ascertain if there is a chance of debonding? Appreciate your guidance!
That's fairly common actually. The main reason is a lack of proper seal in some areas of the composite. You also have to see whether the sensitivity is due to biting, which is likely due to cuspal deflection due to improper bonding, or merely cold sensitivity or if you're running an explorer on the tooth causing sensitivity. Those are all poor bonding technique and allowing for small areas where no bonding is present on the surface of etched dentin, causing fluid movement in the tubules. All those can generally be resolved if you remove the entire composite and replace it with a sedative filing and observe the symptoms. If they improve, go back to a new, better sealing composite. If they don't, then endo may be required.
amazing profound
Thank u very much. Just superb
Thank you Doc!
thankyou sooo much sir that was really helpful :)
thanku sir fr ur valuable lecture
Background music fantastic
Informative
Reversible pulpitis why dull pain non continous intermittent in character... Tou told that a fibres are situated periphery...
If the caries reaches near to pulp most of the patient will have dull pain less intensity
Whats the reason for that
If the caries reaches the pulp it's generally considered irreversible pulpitis. The dull ache is the spontaneous component of pain, which is generally from the pulp proper (c-fibers). They feel the A-fibers whenever they have something cold given their decay! (sharp shooting pain!)
I just want to ask any dentists out there- is it normal to open and drill dentin out then remove some abscess from roots and not finish root canal fully and just close it? Thats what my dentist did and i feel pain whenever my treated tooth touches the tooth in the bottom.. he said he cant finish the root canal due to covid 19. The treated tooth also has a minor crack, so im worried it will just break although im being really careful not to put any stress on it. Any advice would be appreciated.
Frome my deepst harte very huge respect and thanx alot
may i know why in cases of pulp canal obliteration,the electric pulp test shows delay response...tq
Doc could you please explain why we need to de-occlude after endodontic treatment or is it really necessary??? because patients complain of POP a lot of times if the RCT procedure is planned for 2-3 seatings
thankyou
Not sure what you mean by de-occlude... do you mean remove the smear layer or to achieve patency through apex? Most cases can be done in a single visit if you understand the underlying principles of success and your efficient enough in applying the required protocol for success. Cheers!
Is this possible, the pulp is necrotic but no caries/whole in the crown/root area?
Yes, it's more common than one would think. In about 7% of the population, the cementum doesn't cover the root around the CEJ. In canine teeth and some other anterior teeth, this can cause infection through these tubules that along with possible cases of ortho or trauma, can cause necrosis. Sometimes these teeth are necrotic but asymptomatic. Other times, they can become symptomatic. But over all, it's very possible to have necrosis in what appears to be a virgin tooth. It's very important to do proper vitality tests with cold (comparing to the contralateral side) as well as EPT to make sure before cutting into the tooth. Cheers!
so how sweets can cause pain what is the mechanism?
Dr. Nasseh...I have one question
Is it true that after root canal therapy the tooth is actually not dead because it still has blood supply from periodontal ligament? Please throw some light on it considering my question...
Love from India...
grt explanation sir :)
I often wonder why after chewing something sour like a piece of lime, even after washing and after couple of days, that teasing sensation last s?
thank you so much it so relevant !!!!!
thanks, sir
u r awesome :) thanq somuch !
Feynman of teeth? That made perfect sense.
The pulp has a special odor which the patient probably sense each time the file is passed under his or her nose.
very nice
Frome my deepest harte ve
If i thank you, it will be very less than your effort. I have nothing to give you against the knowledge you share with us.
thnkx sir