Do we still need formocresol in pediatric dentistry?

Most pediatric dentists in the United Kingdom and North America1,2 use formocresol pulpotomy for vital primary pulp therapy. In the United Kingdom, 54% of pediatric dentists reported concerns about possible sensitization, toxic, mutagenic or carcinogenic effects of formocresol; 42% of specialists surveyed in 2002 were considering changing their pulp technique to avoid formocresol.1 We performed a telephone survey of directors of Canadian pediatric dentistry programs to determine undergraduate teaching for management of vital primary pulps. The formocresol pulpotomy, one-fifth dilution or full-strength, continues to be the standard for didactic and clinical training of Canadian undergraduates. Although many programs provide didactic instruction in alternative techniques, fewer than a third offer clinical exposure to nonaldehyde methods. One program does not offer didactic or clinical training in formocresol pulpotomy. Clinicians who are considering alternatives to formocresol use in pediatric dentistry will benefit from this review of clinical investigations. Alternatives to the formocresol pulpotomy should demonstrate equivalent efficacy in well-designed clinical trials and reduce safety concerns through the use of nonaldehyde alternatives. Concerns about Formocresol Concerns about the safety of formocresol have been appearing in the dental and medical literature for more than 20 years.3–7 Cresol is locally destructive to vital tissue, but its potential for systemic distribution following pulpotomy treatment is negligible.8,9 The major concern has been with the formaldehyde component of formocresol. Although a 1:5 dilution of formocresol is specified in undergraduate curricula, most (78%) American pediatric dentists who use formocresol in primary tooth pulpotomy use it at full strength (19% or 48.5% formaldehyde). Only 2% of American pediatric dentists use a predictably accurate dilution of formocresol.10 Formaldehyde has been shown to be distributed systemically after pulpotomy. Up to 10% of the formaldehyde from a formocresol pulpotomy was absorbed systemically in dogs.11 In a separate study, radioactively labelled formaldehyde was distributed throughout the viscera of rats following formocresol pulpotomy in a single molar.12 At least 3 areas of concern have been reported with regard to formocresol: mutagenicity, carcinogenicity and immune sensitization. Antibody formation leading to immune sensitization to formaldehyde after formocresol pulpotomy has been demonstrated in dogs.13 Mutagenic and carcinogenic effects of formaldehyde exposure were demonstrated in Dr. Casas E-mail: [email protected] Contact Author Do We Still Need Formocresol in Pediatric Dentistry?