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Pulpotomy in primary teeth using the formocresol method results in varying degrees of devitalization of the root pulp. The extent of this devitalization depends on, among other things, the ability of the components of formocresol to leave the dressing. The purpose of this study was to evaluate the rate and duration of diffusion of the components of formocresol when incorporated in different vehicles. The antimicrobial effect of the drugs was used to assess the diffusion of the components of formocresol in blood agar, with a sensitive microorganism as an indicator. Evaluation of the MICs assessed in broth medium for formalin, formocresol and cresol, respectively, and the zone size of growth inhibition on blood agar from these components when incorporated in ZnO or ZnO-eugenol cement, suggested that the initial zone of inhibition from formocresol was due mainly to the diffusion of formaldehyde. Cresol diffused more slowly from the dressing. The presence of eugenol in the dressing, as in ZnO-eugenol cement, gave smaller initial release of formaldehyde, formocresol and cresol compared with the release from ZnO, but more prolonged diffusion. A higher initial release of formaldehyde was obtained when the formocresol was incorporated in ZnO alone compared with ZnO-eugenol cement or Pharmatec.
Calf pulp was treated with full-strength formocresol, diluted formocresol, or saline for 4 hours. After washing and homogenization, the water extractable supernates were analyzed for total amino acid, carbohydrate, and hydroxyproline content. Additional samples were tested against trypsin, pepsin, collagenase, and hyaluronidase. Other tissue samples treated with 1/5, 1/10, and 1/25 dilutions of formocresol were subjected to trypsin and collagenase. The control tissue gave 50 per cent more extractable material, which contained over 300 per cent more total amino acids and hydroxyproline but only slightly more carbohydrate than the treated tissue. Formocresol treatment produced an 80 to 90 per cent reduction in reactivity to trypsin, pepsin, and collagenase but little change from hyaluronidase action. The increase in reactivity of the tissue to enzyme hydrolysis paralleled the increase in dilution of formocresol. These results indicate a profound effect on the protein fraction of pulp exposed to full-strength formocresol.
Bacteriologic studies indicate that 50 percent formocresol in propylene glycol is an efficient bactericide. The tissue-irritation potential of this concentration was evaluated in rats. Assessment of the subcutaneous connective tissue reactions to 50 percent formocresol, 100 percent formocresol, and normal saline solution (as a control) indicates that formocresol, when diluted with propylene glycol, is significantly less irritating to the subcutaneous connective tissue of rats. The atraumatic implantation technique also seems to influence significantly the intensity of tissue reaction. Dilute formocresol deserves further study to evaluate its use in clinical endodontics.
Pulpotomies were performed on rhesus monkeys with use of formocresol to determine if there was uptake of 14C-formaldehyde into the systemic circulation after formocresol pulpotomies. Five-minute exposure of pulpal tissue to the 14C-formocresol resulted in the systemic absorption of approximately 1% of the dose. Two hours of exposure of pulp tissue to the 14C-formocresol did not increase the systemic absorption. Multiple sequential pulpotomies resulted in proportionately higher systemic absorption of 14C-formaldehyde. Application of 131I to pulpotomy sites indicated that formocresol compromises the microcirculation of the dental pulp. Autoradiography disclosed extensive concentrations of 14C-formaldehyde in the pulp, dentin, periodontal ligament, and bone.
After pulpal extirpation of twenty teeth in each of five dogs, these animals were primarily immunized intramuscularly by combining formocresol with the dog's own pulp (three dogs), saline solution with pulp (one dog) and injecting sheep erythrocytes (one dog). A sixth dog was used as a control for the Arthus skin test. Secondary immunizations were accomplished via the root canal every 7 days over a 28-day period. Arthus skin-test reactions demonstrated less of a response to the formocresol alone than when the dogs' pulp was conbined with this material. In vitro analysis of hemagglutinating antibody titer showed a tremendous increase when pulp was incubated with formocresol as compared to the saline-treated pulp. Therefore, dogs' pulp tissue became antigenically altered by the formocresol recognized by the host, and a specific humoral response resulted.
14C-Formocresol and 14C-glutaraldehyde were placed in the root canals of freshly extracted human teeth. The outward diffusion of labeled aldehydes was then measured and autoradiograms of cross-sections taken. No diffusion of glutaraldehyde was detectable within 72 hours, whereas there was a rapidly increasing outflow of formocresol during the same period. In a separate group normal root canal treatment was completed until 2 mm. short of the roentgenologic apex with glutaraldehyde as an irrigant. The walls of the root canals of some of the specimens were examined with electron microscopy and the outflow of 14C-formocresol which was later placed in some specimens was counted. The use of glutaraldehyde as an irrigant resulted in closure of the apical third of the root canal as indicated by the absence of 14C-formocresol diffusion.
The in vitro antimicrobial and cytotoxic concentrations of glutaraldehyde and formocresol were determined. Minimal antimicrobial concentrations of these two agents against selected microbial flora reported in carious primary teeth were 3.125% for glutaraldehyde and 0.75% for formocresol. At a doubling of these concentrations, most organisms, except Candida albicans, Staphylococcus epidermidis, and Streptococcus mutans, were killed by both substances in 30 seconds. Cytotoxicity was evaluated on tissue cultures of pulp fibroblasts and HeLa cells at minimal cidal concentrations and at 10- and 100-fold dilutions. Exposure of pulp fibroblasts and HeLa cells to formocresol and indirect exposure to vapors caused the cells to become atrophic and to form a less dense tissue pattern. Cells directly exposed to glutaraldehyde retained their normal cell shape and tissue pattern, whereas cells indirectly exposed to vapors continued to proliferate. These data showed effective antimicrobial activity at concentrations of 3.125% glutaraldehyde and 0.75% formocresol and suggested that glutaraldehyde may exert a less cytotoxic effect on the immediate and surrounding tissues when used as a pulpotomy agent.
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.
The purpose of this investigation was to evaluate clinically and radiographically primary molars with necrotic pulps treated with two different formocresol concentrations (full-strength formocresol and 20% dilution of formocresol). A total of 50 cases were evaluated at 3, 6 and 12 months after the treatment. There were not significant statistical differences in the results obtained between both concentrations; therefore it can be conclude that the 20% dilution of formocresol represent a satisfactory treatment for primary molars with necrotic pulps. Due to this findings is possible to assure that this procedure in easy, reliable and cheap; and also is possible to apply to all ages and socioeconomic label.
Based on the limited results of this eight-week comparison of formocresol and glutaraldehyde, it would appear that glutaraldehyde may offer distinct advantages over formocresol, in the treatment of cariously exposed primary and young permanent teeth. In particular, due to its chemical structure, it is more active in fixing the surface tissues and is more rapidly limited in its depth of penetration through these tissues. Glutaraldehyde does not exhibit as significant an ability to induce the total loss of vitality, in the radicular pulp tissues. The progression of formocresol treated pulps to apparent fibrotic replacement via granulation-tissue ingrowth, through the apex, does not occur with the glutaraldehyde-treated pulp tissues. There may, however, be a slow progression of fibrotic replacement of the glutaraldehyde fixed tissue, in the coronal portion of the radicular pulp. Perhaps most importantly it would seem that since the glutaraldehyde does not perfuse the tissues to the apex, it will not demonstrate systemic distribution and other extradental phenomena, as have been identified with the use of formocresol
The state of the pulp of twenty-seven primary teeth treated by formocresol pulpotomy (clinically and radiographically successful) was assessed 3 to 5 years after treatment. A wide variation was found in the pulpal condition, from normal pulp tissue to total necrosis. Resorption and apposition of hard tissue were common findings. Five teeth were freeze-sectioned and incubated for histochemical demonstration of oxidative enzymes. The pulps of two teeth were vital; two teeth had necrotic areas subjacent to the amputation paste; and one pulp was totally necrotic. Six teeth were extracted 5 minutes after formocresol pulpotomy and incubated for demonstration of oxidative enzymes. An unstained zone, 1 to 2 mm. deep, was seen in all incubated sections. In conclusion, it seems that the formocresol method should be regarded only as a means to keep primary teeth with pulp exposures functioning for a relativley short period of time.
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.
Formocresol and eugenol are the two nonspecific intracanal medicaments commonly used in endodontic practice. Both have high tissue irritation potential when used in conventional strength. Propylene glycol is an alcohol that is injectable and itself possesses significant antibacterial action. It is a popular vehicle and hence was used to modify the two drugs. Standard bacteriologic methods were employed to test the antibacterial action of these lower concentrations of the two drugs against four test organisms. The investigations indicate that formocresol at as low as 10 to 20% and eugenol at 75% are bactericidal in action and hence may be useful at these concentrations for clinical use. Evaluation of these lower concentrations is warranted for possible clinical use. Propylene glycol, which possesses antibacterial action and is remarkably innocuous to tissues, appears to be a suitable vehicle for dilution of formocresol and eugenol.
The root canals of twelve pairs of human incisors without hard tissue or periodontal disease were treated with either formocresol or glutaraldehyde. The periapical reactions were compared histologically after periods varying between 6 and 8 weeks. A formocresol dressing always resulted in irritation of the periapical tissues, whereas little or no irritation was found after treatment with glutaraldehyde. It can be concluded that, after a vital pulpectomy, treatment of root canals with glutaraldehyde is faster than, as efficient as, and less irritating than treatment with formocresol.
Formocresol was checked with respect to its in vivo fixative effect after pulpotomy, through observation of tissue resistance to necrosis. The root pulps were freed from their hard-tissue wrapping and processed for 48 hours, followed or not by capping (15 days) with zinc oxide-eugenol or with zinc oxide-eugenol-formocresol. The effect of only capping with zinc oxide-eugenol, with or without formocresol, was also recorded.