“New Age” Pulp Therapy: Personal Thoughts on a Hot Debate

Author(s): Paula Jane Waterhouse
Journal: Pediatric Dentistry
Volume (number): 30, #3
Month, Year: May/June 2008
Major topic: Vital pulp therapy and use of formocresol
Minor topics:
Type of Article: A review
Main Purpose: To review reasons against the use of formaldehyde-containing preparations in dental care of children
Findings:
Contrary to the idea that primary tooth pulps present a more pronounced inflammatory reaction compared with permanent teeth, recent data has demonstrated equality in dentitions for the degree of vasodilation and angiogenesis in response to a caries insult. Primary teeth have a good potential for tissue repair and healing. In light of these recent findings approaches to pulp therapy need to be updated.
54% of the 184 surveyed British pediatric dentists expressed concern over the safety of formocresol
Although the amount of formocresol used in practice is small (20% dilution of Buckley’s formocresol) further research is needed to investigate effects on both patient and clinicians over long-term use in a clinical setting. Currently there is nothing published related to the possible levels formaldehyde and cresol vapor in the dental working environment.
Formaldehyde passes into tissues such as mucous membranes readily but uptake into skin is poor. Tricresol is said to decrease the solubility and diffusion of formaldehyde, thereby reducing movement out of the root canal. However, because tricresol can disrupt cell membrane lipid components some fear potentiation of local caustic effects of formaldehyde could occur.
Formaldehyde is an irritant to the eyes and respiratory tract in amounts as low as 0.1ppm in some humans. Workers exposed to chronic levels of 0.2-2ppm exhibit mild epithelial lesions. In a 2005 incident a 1-ounce spill of Buckley’s formocresol caused a dental clinic to close for the rest of the day and 10 individuals required emergency room treatment for breathing difficulty. The UK’s Health and Safety executive branch states that there is “increased concern” for the carcinogenic potential of formaldehyde in humans, particularly in relation to nasopharyngeal cancer, but data falls short of producing conclusive evidence.
Alternative techniques for vital pulp therapy of irreversibly inflamed teeth may not be as successful as formocresol. In this area further research is needed if we are to move away from the use of formocresol.
Current UK guidelines reflect a shift away from the use of formocresol, however it remains listed as a medicament option.
Key points/Summary: Although there is an obvious emphasis on moving away from the use of formocresol in pediatric dentistry an adequate alternative must be found before this occurs.
Assessment of article: Fair article. Good superficial review of the negative aspects of using formocresol. Would have liked to see more substance.