Search

Anaphylactic shock is a real and life threatening medical emergency which is encountered in every field of medicine. The coronary arteries seem to be the primary target of anaphylaxis resulting in the development of Kounis syndrome. Kounis syndrome is a pan-arterial anaphylaxis -associated syndrome affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of mast cell activation disorders. Recently, Kounis-like syndrome affecting the cerebral arteries was found to be associated with mast cell activation disorders. In anaphylactic shock, the decrease of cerebral blood flow is more than what would be expected from severe arterial hypotension. This is attributed to the early and direct action of anaphylactic mediators on cerebral vessels. While adrenaline is a life saving agent in the treatment of anaphylactic shock, it contains sodium betabisulfite as preservative and should be avoided in sulfite allergic patients. Potential allergens encountered in endodotic practice include formocresol, zinc compounds thiurams, sodium dimethyldithiocarbamade, and mercaptobenzothiazole that might have synergistic action. All these agents together with analgesics, antibiotics, antiseptics, formaldehyde, latex, local anaesthetics and metals used in dental practice, in general, can induce anaphylactic shock. Practitioners should be aware of these consequences. A careful history of previous atopy and reactions is of paramount importance for safe and effective management., (© 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Background: Mesenchymal stem cells (MSCs), a subpopulation of adult somatic stem cells, are an attractive stem cell source in regenerative medicine because of their multipotentiality. In this study, the effects of MSCs transplantation on oral ulcer healing were examined., Methods: Mesenchymal stem cells were isolated from bone marrow aspirates of dogs by dish adherence and expanded in culture. Oral ulcers were induced by topical application of formocresol in the oral cavity of dogs. Either autologous MSCs or vehicle (saline) was injected around the ulcer. The healing process of the ulcer was monitored clinically and histopathologically. Gene expression of vascular endothelial growth factor (VEGF) was detected in MSCs by reverse transcription-polymerase chain reaction. Expression of VEGF and collagen genes was detected in biopsies from all ulcers., Results: Mesenchymal stem cells expressed mRNA for VEGF MSCs transplantation significantly accelerated oral ulcer healing compared with controls. There was increased expression of both collagen and VEGF genes in MSCs-treated ulcers compared with controls., Conclusion: Mesenchymal stem cells transplantation may help accelerate oral ulcer healing, possibly through the induction of angiogenesis by VEGF together with increased intracellular matrix formation as detected by increased collagen gene expression.

Concern has existed for almost 10 years regarding the safety and efficacy of formaldehyde-based medicaments like formocresol in dentistry. Formocresol has been shown to be therapeutically outdated for decades. While the use of formocresol around the world continues to drop, it still is utilized in alarmingly high rates, an age-old bias that is unsubstantiated by overall academic research. Formaldehyde remains a genotoxic and carcinogenic problem worldwide. The most recent articles are discussed in light of the need to abandon formocresol.

Concern has existed for almost ten years regarding the safety and efficacy of formaldehyde-based medicaments like formocresol in dentistry. Formocresol has been shown to be therapeutically outdated for decades. While the use of formocresol around the world continues to drop, it is still utilised in alarmingly high rates, an age-old bias that is unsubstantiated by overall academic research. Formaldehyde remains a genotoxic and carcinogenic problem worldwide. The most recent articles are discussed in the light of the need to abandon formocresol.

Aim: To compare the outcome after 6 months of the application of formocresol (FC) or mineral trioxide aggregate (MTA) during pulpotomy in primary molar teeth., Methodology: A maximum of 126 children (aged 5-9 years) with carious primary teeth that required pulpotomy were selected. Following randomization, a standard pulpotomy preparation was undertaken, and the coronal pulp removed and bleeding arrested. In the FC group, cotton balls, soaked in FC, were placed for 5 min, and then the pulp chamber was filled with Zonalin, a pulpotomy agent. In the MTA group, a 1-mm-thick paste of MTA was used as a pulpotomy agent. The crowns in both groups were restored with amalgam or glass ionomer. The teeth of 100 patients were evaluated and compared clinically and radiographically after 3 and 6 months., Results: No signs of clinical failure were observed at the 3- and 6-month follow-up appointments in either group. There were no significant differences in the radiographic findings of the teeth and surrounding tissue at the 3-month follow-up. However, at the 6-month follow-up, significantly more cases (P = 0.036) with root resorption were seen in the FC group; no cases of resorption occurred amongst the MTA cases. The surrounding tissue showed radiographic signs of post-treatment disease in four FC cases; none was seen in the MTA cases., Conclusion: After 6 months, pulpotomy with MTA was associated with fewer cases of root resorption and post-treatment disease. MTA appears to be a reliable alternative material for pulpotomy in primary molar teeth.

Objective: To produce a working clinical protocol for pulp therapy techniques in the extensively carious primary molar., Introduction: The International Agency for Research on Cancer has recently classified formaldehyde as carcinogenic to human beings. As such, a medicament that can be used to replace formocresol in clinical practice should be identified., Methods: Part I of this paper explored the currently available alternative interventions and materials to formocresol in the form of a narrative review following an extensive literature search. Part II now presents the formation of a specialist group to establish an evidence-based protocol, for the management of the extensively carious primary molar., Conclusion: A protocol and key points document have been developed to assist clinicians in their treatment planning. Areas for further postgraduate training are identified.

Background: Iatrogenic trauma can be defined as any trauma that has been induced by the dentist's activity, manner, or therapy. The aim of this article is to present traumatic oral tissue lesions of iatrogenic origin., Methods: Thirteen cases of chemical (due to ferric sulfate and formocresol), physical (due to orthodontic wires and appliances), and thermal (due to electrosurgery) injuries to the oral tissues are reported., Results: Chemical, physical, and thermal injuries in the oral, gingival, or palatinal mucosa of iatrogenic origin can exhibit various clinical features. The management of traumatic injuries is dependent on the severity of the involvement in the periodontal tissues. While, in most cases, the elimination of the offending agent and symptomatic therapy were sufficient, in severe cases, or when the injury resulted in permanent defects, periodontal surgery and regenerative therapy may be necessary., Conclusions: The skill, experience, and up-to-date knowledge of dentists are the main factors to prevent possible iatrogenic traumas. Although "To err is human," careful practice is very important for the principle "Primum non nocere" ("First do no harm").

Purpose: The objective of this study was to assess the effect of mineral trioxide aggregate (MTA) as pulp dressing material following pulpotomy in primary molars with carious pulp exposure and compare them to those of formocresol (FC)., Methods: Of 33 children, primary molars treated via a conventional pulpotomy technique were randomly assigned to the MTA group (33 teeth) or FC group (29 teeth). Clinical and radiographic follow-up ranged between 4 and 74 months. The mean follow-up time was 38 months, with no difference between the groups. Twenty-nine teeth were followed until uneventful shedding (mean=33 months). Failures were detected after a mean period of 16 months (range=4 to 30)., Results: The success rate of pulpotomy was 97% for MTA (1 failure) and 83% for FC (5 failures). Eight teeth presented internal resorption. In 4 of them (2 of each group), progress of the resorption process stopped and the pulp tissue was replaced by a radioopaque calcified tissue. Pulp canal obliteration was observed in 58% of the MTA group and in 52% of the FC group (total=55%)., Conclusions: MTA showed a higher (though not statistically significant) long-term clinical and radiographic success rate than formocresol, and can be recommended as its replacement as, unlike FC, MTA does not induce undesirable responses.

Objectives: To investigate whether formocresol, in Buckley's original formulation, is mutagenic in vivo to lymphocyte cultures obtained from the peripheral blood of children aged from 5 to 10 years old. These children were recruited from those attending the dental clinics of Recife City Council and the University of Pernambuco School of Dentistry, Brazil., Methods: The sample comprised 20 children who had primary teeth with cariously exposed vital pulps. Two venous blood samples were collected (6-8 ml) from each child, the first prior to vital pulpotomy (control group) and the second 24 h after pulpotomy (treated group). This research is a case-control study. The peripheral lymphocytes were grown in a complete culture medium consisting of 78% RPMI 1640 medium (a), supplemented with streptomycin (0.01 mg/ml), penicillin (0.005 ml(-1)), 20% fetal bovine serum (b) and 2% phytohemagglutinin (c). The lymphocytes were assessed for chromosomal aberrations via a previously published method which was modified. The cytogenetic analysis was performed in a blind test, where the slides were codified by an annotator and the scorers did not know which group they were analyzing. For each sample, this envolved the analysis of 200 metaphases. The level of significance adopted in the statistical test was 5.0% (p<0.05)., Results: There was no statistically significant difference in clinical doses between the control and treated groups, using Wilcoxon's Signed Ranks test, for the chromosomal aberrations (P=0.251) and for the total chromosomal breaks (P=0.149). Although there were no statistically significant differences between the control and treated groups, Buckley's formocresol was mutagenic for one patient, raising doubt about the desirability of its use for pulpotomies in children., Conclusions: The results revealed that, from a statistical standpoint, formocresol is not mutagenic. However, further investigations are required, preferably with a larger sample, in patients needing more than one pulpotomy in order to observe whether an increase in the quantity of the drug would increase the quantity of chromosome aberrations and also to verify individual susceptibility to chromosome alterations with the use of formocresol.

Since its introduction in 1904, formocresol has become one of the most widely studied dental medicaments. In the United Kingdom, it is the preferred primary tooth pulpotomy medicament of the majority of Specialists in Paediatric Dentistry. Reports of adverse effects resulting from its clinical use are rare. This paper presents a case of premature exfoliation of primary molars that may be related to the use of formocresol in a multivisit pulpotomy technique.

Objectives: This study was designed to examine the attitudes and practices of Specialists in Paediatric Dentistry practising in the United Kingdom in relation to vital pulpotomy in the primary dentition., Design: Data were collected by postal questionnaire., Sample and Methods: All dentists whose names were entered on the General Dental Council's Specialist List in Paediatric Dentistry, and who were resident and practising in the United Kingdom, were asked to complete a questionnaire consisting of nine questions., Results: Questionnaires were returned by 184 (86.8%) of the eligible Specialists in Paediatric Dentistry. These yielded a sample group of 179 Specialists practising the primary vital pulpotomy technique. The most commonly used medicament was formocresol, with a 1 : 5 dilution being used by 66.5% of the sample. More than half (54.2%) of the Specialists practising the technique expressed concern regarding their preferred medicament. Without exception, their concerns related to the potential adverse effects of formocresol and formaldehyde. Seventy-five respondents (41.9% of the sample) were considering changing their technique. One hundred and thirty-seven Specialists stated that they routinely took preoperative radiographs, while postoperative radiographs were routinely taken by 107 Specialists (76.5% and 59.8% of the sample, respectively). Rubber dam isolation was used by 62.6% of the sample., Conclusions: The majority of Specialists are adhering to the UK national clinical guideline for pulp treatment of the primary dentition. However, significant numbers are considering changing their chosen technique. There is a lack of consensus on the use of pre- and postoperative radiographs; specific guidance with respect to their use is required.

A 68-year-old woman received a formocresol pulpectomy of the right lower lateral incisor. The temporary restoration was lost within hours. The next day, the patient suffered continuous pain, the gingiva sloughed, and the alveolar bone was exposed. Four days after treatment, the patient complained of moderate pain. Six days after the pulpectomy, the tooth spontaneously exfoliated. At this time she was referred to our hospital. The clinical diagnosis was chronic alveolitis. Treatment consisted of irrigation of the area. Three weeks after the pulpectomy, the dull pain had subsided, but the alveolar bone of the area showed increased mobility. Five weeks after the pulpectomy, the mobility of the alveolar bone was more significant and a sequestrectomy was performed with the patient under local anesthesia. The sequestrum of necrotic bone was approximately 10 x 5 x 5 mm in size. The patient has been symptom-free for 2 years since the sequestrectomy.

Studies have suggested that formocresol has toxic and carcinogenic potential. A search for an alternative medicament for primary tooth pulpotomies has led to ferric sulfate as a possible alternative. A retrospective study was done in a multipractitioner IHS (Indian Health Service) clinic. Radiographic success or failure was determined for 202 primary tooth pulpotomies performed with either formocresol, ferric sulfate, or a combination procedure of formocresol and ferric sulfate. The post-operative period for the pulpotomies ranged from one month to thirty-six plus months. There was no statistical difference in radiographic failure rates between formocresol, ferric sulfate, or the combination procedure when results were analyzed regardless of post-op period. However, when post-op periods were considered, formocresol performed better at > 36 months and the combination procedure showed significantly more failures at > 36 months.

The purpose of this study was to compare pulpal and periapical tissue reactions to electrosurgery versus formocresol pulpotomy techniques in the primary teeth of dogs. The study was conducted on 33 primary teeth of three mongrel dogs between the ages of one to three months. Each dog had three teeth treated by Formocresol Pulpotomy with Mechanical Coronal Pulp Removal (FC), three teeth treated by Electrosurgery Pulpotomy with Mechanical Coronal Pulp Removal (ES/MCPR), three teeth treated by Electrosurgery Pulpotomy with Electrosurgical Coronal Pulp Removal (ES/ECPR), and two teeth serving as untreated Controls. Dogs one, two and three were sacrificed performing the pulpotomies at two, four and six weeks, respectively. The pulp, periapical tissue and after surrounding bone were submitted to histological examination and the histological reaction was recorded. The results were fourteen out of 18 unfavorable and zero out of three favorable histological reactions occurred in the FC treated teeth. Six out of 18 unfavorable and one out of three favorable histological reactions occurred in the ES/MCPR treated teeth. Nine out of 18 unfavorable and two out of three favorable histological reactions occurred in the ES/ECPR treated teeth. One out of 18 unfavorable and zero out of three favorable histological reactions occurred in the untreated Control teeth. The conclusion of this study is that of the three experimental groups, the teeth treated by Electrosurgery Pulpotomy with either Mechanical or Electrosurgical Coronal Pulp Removal exhibited less histopathological reaction than the teeth treated by Formocresol Pulpotomy.

A clinical case report is presented which describes the sequelae of an iatrogenic lateral crown/root perforation and a formocresol pulpotomy. The post-operative course of the initial therapy included significant hard and soft tissue destruction and eventual tooth loss. The possible implication of the role of formocresol is discussed.

Some concern has been expressed in recent years about the use of formocresol for vital pulpotomy treatment of primary molars. This paper reviews the literature concerning the toxicity of formocresol and considers the evidence for the use of calcium hydroxide and glutaraldehyde. It is concluded that more work is required in this field before an alternative to formocresol can be recommended and that, in the meantime, a 1:5 dilution of the standard formocresol solution should be used but not included in the zinc oxide-eugenol sublining.

Following several case reports of cyst development after endodontic treatment of decidous teeth, the osseous response to formaldehyde- or phenol-based materials was evaluated by a standardized radiographic technique. Endodontic medicaments contained in Teflon carriers were implanted between feline deciduous canine and molar teeth and the permanent successional teeth. Persistent radiolucency surrounding formocresol implants and sequestration of Kri-paste implants were noted in contrast to apparent bony healing around the zinc oxide-eugenol controls and those implants containing glutaraldehyde. These results suggest a greater tissue tolerance to glutaraldehyde-containing agents in contrast to the more traditional endodontic agents used in deciduous teeth.

The purpose of the study was to compare the effect of three intracanal medicaments on the incidence of post-instrumentation flare-ups. All teeth were instrumented to a predetermined minimum size using a 0.5% solution of sodium hypochlorite as the irrigant. Formocresol, Ledermix, and calcium hydroxide were placed in strict sequence irrespective of the presence or absence of symptoms or radiographic signs of apical periodontitis. The patients were given written post-operative instructions and a prescription for 600 mg ibuprofen to be taken if mild to moderate pain developed. If severe pain and/or swelling developed the patient was instructed to call the office immediately and was considered to have had a flare-up. Twelve flare-ups occurred in teeth with radiographic signs of apical periodontitis; none in teeth without periapical radiolucencies. Six of the twelve flare-ups occurred in retreatment cases and the other six occurred in teeth without previous endodontic treatment. No significant difference was found in the flare-up rate among the three intracanal medicaments.

Literature reports appeared in the last years suggested that some type of dentigerous cyst (DC) in children would initiate by teh action of other factors than developmental and at different stages of dental sac growth. Periodontitis and pulp therapy with formocresol (FC) have been suggested as aeteological factors, both promoting DC in children by irritation of the underlaying dental sacs of premolar. The purpose of this study is to analyse the pathological changes in DC of patients aged 0 to 15 years, and to compare the findings according to the anatomical site of DC and the existence of previous FC therapy. Morphological changes observed in the epithelium and the connective wall did not show clear differences between both groups of DC. The histometric measurements of epithelial changes did not show significant statistical differences of various parameters in the DC walls. These facts would not support the hypotesis of DC initiation from FC effects.

Histological examination was carried out of milk molars involved by physiological or pathological resorption, i.e. accelerated, during treatment of pulp diseases by amputation using formocresol, and delayed in case of persisting milk teeth. The results showed that the histological pattern of accelerated resorption due to formocresol was not different from physiological resorption. Delayed resorption was associated with an evident repairing reaction in the resorption sinuses.

This study compared Dycal and formocresol pulpotomies on young healthy permanent teeth with respect to continued dentinogenesis and root end development. Pulpotomy was performed on a total of forty permanent teeth with incompletely developed roots in three young stump-tailed monkeys (Macaca speciosa). Twenty teeth were treated with Dycal and twenty with formocresol. At the end of the experimental periods the animals were killed and the specimens were prepared and sectioned en bloc for histologic examination. The interval between treatment and death ranged between 7 and 797 days. Before each experimental procedure a Procion vital dye was administered as a marking agent for continued root development. Twelve of twenty teeth treated with Dycal and seventeen of twenty teeth treated with formocresol were judged to be successful as evidenced by continued root development, absence of periapical pathoses, and the presence of noninflamed or only mildly inflamed pulps. Brown and Brenn staining showed bacteria within the pulps of the teeth that failed. All but one of the teeth in this study showed evidence of continued root development as confirmed by Procion labeling.

Twenty-five permanent premolars were evaluated for enamel defects. The primary molars that they succeeded had been successfully treated with a formocresol pulpotomy. A relationship between the enamel defects and the pulpotomy procedures has been found.

In the context of a study of the development of enamel lesions in permanent successors of primary molars treated by formocresol pulpotomy, a comparative clinical study was performed of 278 premolars divided equally between test side and control side. These teeth were assessed by two observers who, when finding enamel lesions, always differentiated between opacities and hypoplasias. The principal conclusions from this study are the following: The degree of agreement between the two observers was 96 percent. There was no significant difference in number of teeth with enamel lesions, between test side and control side. When the observed teeth with enamel lesions were related to the age at which pulpotomy was performed, the difference was still insignificant. Separate comparison of opacities and hypoplasias likewise showed no significant differences, even if related to age at which pulpotomy was performed. A formocresol pulpotomy exerts no influence on the size of enamel lesions found in permanent successors of the teeth on which pulpotomies were performed. The general conclusion from the results of this study is that formocresol pulpotomy is a successful technique for the treatment of primary teeth, not only as regards the life-span of these primary teeth (see Part I of the study) but also in terms of its effect on their permanent successors.

For many years there has been controversy over the value of antimicrobial drugs for intracanal dressings in endodontics. Formocresol, a formaldehyde compound, has evolved as the preferred drug for routine endodontic procedures, as well as pediatric endodontics. The increase in the use of formaldehyde has been complicated by the introduction of paraformaldehyde pastes for filling root canals. Neither of these formulas has ever been standardized. The doses are arbitrary, and the common dose of formocresol has been shown to be many times greater than the minimum dose needed for effect. The efficacy of paraformaldehyde pastes is questionable and remains clouded by inconclusive evidence, conflicting research, inadequate terminology, and a lack of convincing statistical evidence. The clinical use and delivery of formocresol and paraformaldehyde pastes remain arbitrary and unscientific. Formaldehyde has a known toxic mutagenic and carcinogenic potential. Many investigations have been conducted to measure the risk of exposure to formaldehyde; it is clear that formaldehyde poses a carcinogenic risk in humans. There is a need to reevaluate the rationale underlying the use of formaldehyde in dentistry particularly in light of its deleterious effects.

The relationship between formocresol, glutaraldehyde-calcium hydroxide and glutaraldehyde-zinc oxide eugenol pulpotomies on primary teeth and enamel defects on the permanent successor were evaluated. There were no significant differences between the test and control groups.