“New Age” Pulp therapy: Personal Thoughts on a Hot debate

Resident: Roberts

Date: 10/1/10

Article title: “New Age” Pulp therapy: Personal Thoughts on a Hot debate

Author: Waterhouse, Paula Jane

Journal: Pediatric Dentistry

Year: 2008

Discussion:

The treatment of pulp tissue has remained very controversial for hundreds of years. In the 1700’s and early 1800’s metal foils were used to cap exposed pulp tissue. Gold and lead were the materials of choice for this procedure but each one had its reasons for being liked and disliked at the time. The clinician had to also decide before treatment whether to cauterize the tooth with a red-hot iron wire before the foil was placed. As treatment advanced in the mid 1800’s a wide range of techniques became available and popularized for the clinician to choose from such as: asbestos fibers, cork, beeswax, pulverized glass, calcium compounds and others based on eugenol. During this time, much controversy existed over whether or not the pulp tissue was capable of healing on its own or not. Formaldehyde first became known in 1874 after an article was published in which 8000 teeth received an application of tricresol-formalin tanning agent. It remained largely unpopular until the Buckley’s method was produced in 1904 containing equal parts of tricresol and formalin. Over the next few years different preparations of formaldehyde evolved and the International Dental Congress became devoted to the study of the pulp and its treatment.

The debate has since continued on which material and method is most effective in treating pulp tissue. Recent studies indicate that the pulp tissue has in some measure the ability to repair and heal itself, thus lending to IPC therapies. In addition these studies and others have found that formaldehyde is toxic and possibly carcinogenic. It is accepted that the substance has been found to be a direct acting irritant, and capable inducing mutations and DNA damage upon cell contact. Studies have shown that chronic exposure to the substance at levels of .2 - 2 ppm have exhibited mild nasal epithelial lesions such as loss of cilia, goblet cell hyperplasia, and mild dysplasia. According to other data collected in studies these effects are not seen with short term exposure. Other concerns not understood or studied are the vapor effects on humans, but there is reason for concern as isolated incidences in which solutions of Buckley’s formula have been spilt and have sent people to the Emergency room for reasons related to difficulty breathing and respiratory distress have been reported. As for now formocresol remains the gold standard among pediatric dentist but holds that position with great speculation as to its future pending more research.