Dental CPD Australia

Medicament used for Pulpal Therapy

Formocresol is the most commonly medicament in primary tooth pulpotomy. It is a compound consisting of formaldehyde, cresol, glycerin and water. Although it is known to leach and escape the microcirculation of the pulp, a survey of board-certified paediatric dental practitioners in the United States suggests that the majority of dental practitioners who used formocresol were not concerned with the adverse effects and that those who use formocresol for primary tooth pulpotomies use a full-strength formulation.


Ferric sulfate has gained significant favour because of formocresol's side effects and disadvantages. However, the pulp should be more thoroughly examined to know the full extent of pulpal damage or involvement, as ferric sulfate has the ability to mask the disease process.


Mineral trioxide aggregate (MTA), although cost-prohibitive, offers the best immediate alternative to formocresol or ferric sulfate. As MTA has no fixative properties of its own, accurately analysing the extent of the pulpal disease becomes even more critical to the overall success of the procedure.

Limitations

It is important to emphasise that if the infectious process (in case of dental caries) cannot be arrested, if the bony support cannot be regained, if there is no remaining adequate tooth structure for a restoration, or if excessive pathologic root resorption exists, pulpal therapy will not likely work, and extraction should be considered.


Moreover, apexification, reimplantation of avulsions and placement of prefabricated post and cores are not indicated for primary teeth.


Recommendations


Pulpal therapy requires periodic clinical and radiographic assessment of the treated tooth and the supporting tissues. Postoperative clinical assessment should be performed every 6 months and as part of a patient’s periodic comprehensive oral examinations. Patients treated for an acute dental infection may initially require more frequent clinical re-evaluation. A radiograph of a primary tooth pulpectomy should be obtained immediately after the procedure to document the quality of the fill, help determine the tooth’s prognosis and serve as a comparative baseline for future films; radiographic evaluation of primary tooth pulpotomies should be done annually at the very least because the success rate of pulpotomies diminishes over time.


Clinical signs and/or symptoms of recurrence of dental caries on any tooth that has undergone pulpal therapy should prompt a clinician to select a more frequent reassessment period.


Future studies


Clinicians are continuously challenged to preserve the pulp, either through indirect pulpal therapy or partial pulpotomy. Formocresol and calcium hydroxide pulpotomies, although popular and the treatment of choice of most dental practitioners, may soon be challenged by other chemical treatments, electrocautery or stimulation of reparative dentine by growth factors. Iodoform pastes are promising easier and more successful pulpectomy therapy. Total etch direct bonding materials may soon be used in direct pulp capping as well as partial and complete pulpotomy protocols.


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