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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 4  |  Issue : 2  |  Page : 23-26

Use of formocresol by the pediatric dentists across Chennai: A questionnaire survey


Department of Pedodontics, SRM Dental College, Kattankulathur, Tamil Nadu, India

Date of Submission06-Oct-2021
Date of Acceptance06-Oct-2021
Date of Web Publication29-Nov-2021

Correspondence Address:
Prof. L Jailance
Assistant Professor, SRM Dental College, Kattankulathur, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijosr.ijosr_23_21

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  Abstract 


Introduction: In pediatric dentistry, Buckley first introduced the formocresol as a medicament and to treat the nonvital permanent teeth in 1904. In 1930, sweet introduced the formocresol pulpotomy medicament for primary teeth.[1] The use of formocresol is more controversial than Rotherham medicaments. Other pulpotomy medicaments such as ferric sulfate, glutaraldehyde, calcium hydroxide, MTA, bioactive glass, and morphogenetic protein are used in the treatment of primary pulpotomy.[2] 19% formaldehyde and 35% tricresol, 15% glycerin, and 31% water base are the composition of formocresal. This study aims to inquire about the use of formocresol for primary as well as permanent tooth pulpotomy and to know the awareness about the diluted formulations of formocresol and its adverse effect among Chennai pediatric dentists. Materials and Methods: A questionnaire will be given to 50 pedodontists from Chennai city. The question will be based on whether the practitioners used full-strength or diluted formocresol, the brand and formulation they use and if they use diluted formocresol, how the diluted form is obtain and the knowledge about the adverse effects. Result: About 52% of dental practitioners are using commercially available formocresal. About 21% of them are using chair side preparation formocresal. About 4% of them are using formocresal which is prepared by local pharmacist. 23% of them did not know the dilution formocresal availability. Conclusion: Formocresol is the most popular medicament in the field of pediatric dentistry. This survey concluded that formocresol is a widely used medicament, and it is used as commercially available diluted form by most of the practitioner. This research article focuses on encouraging more researchers to further investigate actual effective dose and concentration for the clinical application for pulpotomy in primary teeth is an important area of further research.

Keywords: Formocresol, pediatrics, pulp therapy, use


How to cite this article:
Megaha, Jailance L. Use of formocresol by the pediatric dentists across Chennai: A questionnaire survey. Int J Soc Rehabil 2019;4:23-6

How to cite this URL:
Megaha, Jailance L. Use of formocresol by the pediatric dentists across Chennai: A questionnaire survey. Int J Soc Rehabil [serial online] 2019 [cited 2024 Mar 28];4:23-6. Available from: https://www.ijsocialrehab.com/text.asp?2019/4/2/23/331464


  Introduction Top


In pediatric dentistry, Buckley first introduced the formocresol as a medicament and to treat the nonvital permanent teeth in 1904. In 1930, Sweet introduced the formocresol pulpotomy medicament for primary teeth.[1] The use of formocresol is more controversial than Rotherham medicaments. Other pulpotomy medicaments such as ferric sulfate, glutaraldehyde, calcium hydroxide, MTA, bioactive glass, and morphogenetic protein are used in the treatment of primary pulpotomy.[2] 19% formaldehyde and 35% tricresol, 15% glycerin and 31% water base are the composition of formocresal.[3] In the composition of formocresol, the formaldehyde is a primary component which is a hazardous substance. This is the center of controversy in pediatric dentistry for more than 20 years.[4] If at a concentration of 20 parts/billion or higher of formaldehyde which leads to health problem given by National Institute for Occupational Safety and Health in the USA state,[5] The International Agency for Research on Cancer stated that formaldehyde causes nasal and paranasal sinus carcinoma.[6] The dilution 1:5 gives effective results given by Morawa in 1975. Some of the studies on formocresol therapy said the clinical success rate between 70% and 90%.[6] Formocresol is safe medicament[7] when it use as diluted form and reduced formaldehyde concentration.

Carcinogenicity of formocresal

That cancer develops in experimental animals once inhalation of air with high concentrations of aldehyde which is content of formocresal is indisputable. These cancers occur as a results of long-run, direct contact the aldehyde and inclined tissues.[8]

The resultant ototoxic effects at these initial contact sites embody ulceration, dysplasia and squamous metaplasia and are thought about to contribute to the next development of cancer.[9] The chance that inhaled or orally eaten aldehyde might induce cancers at sites distant from the metabolism or channel tracts has been investigated in varied long-run toxicity studies performed in rodents.[10] Proof from medicine investigations of commercial staff with exposure to aldehyde offer weak and inconsistent proof that such exposure is related to cancer.[11]

Immune sensitization

The formocresol can produce antigenic activity in dental pulp tissue which was found out from the dog[12] and also found no increase in either immune response or allergic reactions in children who had undergone formocresol pulpotomy.[13]


  Materials and Methods Top


A Questionnaire 1 was given to 50 pedodontist from Chennai city. The question was taken from the research article “Use of Formocresol by the Pediatric Dentist across India – A Questionaire Survey” which was based on whether the practitioners used full-strength or diluted formocresol, the brand and formulation they use and if they use diluted formocresol, how the diluted form is obtain and the knowledge about the adverse effects. The data was analyzed to achieve the results.


  Results Top


[Table 1] represents that 95% of dentist are using formocresal for routine pulp therapy and 5% of them are not using formocresal. 78% of dental practitioners are using formocresal for pulpotomy in permanent teeth and 22% of them are not using formocresal in permanent teeth. 64% of dentists are using formocresal as intracanal medicament and 36% of them are not using formocresal as intracanal medicament. 88% of dentists have done a clinical trials on the use and effect of diluted formocresol. 12% of them have not done a clinical trials on the use and effect of diluted formocresol. 67% of them know that formocresal has carcinogenic effects and 33% of them did not know that formocresal has carcinogenic effects.
Table 1: Use of formocresal for routine pulp therapy

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[Table 2] represents that pulpotomy medicament preference, 66% of dentist prefer formocresal as medicament for routine pulpotomy procedure. Twenty-two percent of them prefer MTA as medicament. Eight percent of them prefer ferric sulfate. Five percent of them prefer some other medicament.
Table 2: Pulpotomy medicament preferences

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[Table 3] represents that formocresal concentration, 24% of dentist are using full concentration of formocresal for pulp therapy procedure. Fifty-four percent of them are using dilute concentration of formocresal. Twenty-two percent of them did not know the concentration of formocresal.
Table 3: Represents that formocresal concentration

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[Table 4] represents that dilution formula knowledge, 8% of dentist had knowledge of dilution formula of R 1:05. Twenty-eight percent of them had knowledge of dilution formula of R 1:25. Ten percent of them had knowledge of dilution formula of R 1:125. 54% of them do not know the dilution formula.
Table 4: Represents that dilution formula knowledge

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[Table 5] represents that dilution formocresal availability, 52% of dental practitioner are using commercially available formocresal. Twenty-one percent of them are using chair side preparation formocresal. Four percent of them are using FORMOCRESAL which is prepared by local pharmacist. Twenty-three percent of them did not know the dilution formocresal availability.
Table 5: Represents that dilution formocresal availability

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  Discussion Top


In this survey, 95% of the dentists are using formocresol for primary tooth pulpotomy. Yoon et al.[14] were conducted a survey on “Preferred treatment methods for primary tooth vital pulpotomies” in that survey 61% of the dentist were used formocresol for primary tooth pulpotomy. The present survey showed that most of the dentists are using diluted concentration for primary tooth pulpotomy. King et al.[14] conducted a survey on the concentration of formocresol used by pediatric dentists in Texas for primary tooth pulpotomy, according to which majority of pediatric dentists are not only still using formocresol for primary tooth pulpotomy. Thirty-three percent of the dentist were used diluted concentration of formocresol.[15] In this survey, majority of the dentist do not know about the formulation of diluted formocresol and 66% of the dentist preferred formocresol for primary tooth pulpotomy than MTA, ferric sulfate, etc. Most of the dentists are using commercially available diluted formocresol for pulpotomy. There is no standardization in the concentration of formocresol available commercially as some of the respondents who buy the diluted form of the medicament commercially but do not know what is its concentration supplied by the manufacturer.[16] In present survey reported that 64% of the dentist are known that the formocresol has carcinogenic effect. Low dose of formaldehyde in the composition of formocresol would not be carcinogenic.[15]

The responses to this survey indicate that there is abundant confusion among practitioner regarding the concentration of formocresol as there is variation in their technique.

More than half of the dentist know and reported that they are using diluted form of formocresol.[17] Twenty-two percent of them are using full strength because they do not know of the dilution formulation. Furthermore, there is no standardization in the concentration of formocresol available commercially as some of the dentist who buy the diluted form of the medicament commercially but do not know what is its concentration supplied by the manufacturer.[18] Pediatric dentists who wish to continue to use formocresol should apply the lowest dose possible using a standardized size cotton or foam pellet for the least possible time to obtain the desired effect.[19] When used judiciously, formocresol is a safe medicinal drug.[20] Hence, it would be wise to use diluted formocresol to lower the formaldehyde exposure to the children.


  Conclusion Top


Formocresol is the most popular medicament in the field of pediatric dentistry. This survey concluded that formocresol is a widely used medicament and it is used as commercially available diluted form by most of the practitioner. This research article focuses on encouraging more researchers to further investigate actual effective dose and concentration for clinical application for pulpotomy in primary teeth is an important area of further research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Questionnaire 1 Top


1. Are you using formocresol for routine pulp therapy procedure in primary teeth?

a) Yes

b) No

2. If No, mention the medicament used and why?

3. Do you use formocresol as an intracanal medicament?

a) Yes

b) No

4. Do you use formocresol for pulpotomy in permanent teeth?

a) Yes

b) No

5. What concentration of formocresol do you use?

a) Full concentration

b) Diluted concentration

c) Do not know

6. If you are using the diluted concentration of formocresol, what is its formulation?

a) 1:5

b) 1:25

c) 1:125

d) Do not know

7. If you are using the diluted formulation of formocresol, how it is made available to you?

a) Available commercially

b) Prepared chair side

c) Prepared by local pharmacist

d) Not available

8. Which medicament will you prefer for routine pulpotomy procedure?

a) Formocresol

b) Ferric sulfate

c) MTA

d) Others

9. Have you done any clinical trials on the use and effect of diluted formocresol?

a) Yes

b) No

10. Do you know formocresal has carcinogenic effects?

a) Yes

b) No

 
  References Top

1.
Ranly DM. Pulpotomy therapy in primary teeth: New modalities for old rationales. Pediatr Dent 1994;16:403-9.  Back to cited text no. 1
    
2.
Mohan GM, Anand VS. Accuracy of different methods of working length determination in endodontics. IOSR J Dent Med Sci 2013;12:25-38.  Back to cited text no. 2
    
3.
Duggal MS. Restorative Techniques in Paediatric Dentistry. 2002. p. 50-63.  Back to cited text no. 3
    
4.
Owen BA, Dudney CS, Tan EL, Easterly CE. Formaldehyde in drinking water: Comparative hazard evaluation and an approach to regulation. Regul Toxicol Pharmacol 1990;11:220-36.  Back to cited text no. 4
    
5.
Tucker SP. Vol. 2. The National Institute for Occupational Safety and Health (NIOSH) Formaldehyde; 2016. p. 5-7.  Back to cited text no. 5
    
6.
International Agency for Research on Cancer, World Health Organization, Press Release No. 153; 15 June, 2004. Available from: http://www.iarc.fr/ENG/Press_Releases/archives/pr153a.html. [Last accessed on 2005 Oct 07].  Back to cited text no. 6
    
7.
Wright FA, Widmer RP. Pulpal therapy in primary molar teeth: A retrospective study. J Pedod 1979;3:195-206.  Back to cited text no. 7
    
8.
Milnes AR. Is formocresol obsolete? A fresh look at the evidence concerning safety issues. Pediatr Dent 2008;30:237-46.  Back to cited text no. 8
    
9.
Salthammer T. The formaldehyde dilemma. International journal of hygiene and environmental health 2015;218:433-6.  Back to cited text no. 9
    
10.
Huang TH, Ding SJ, Hsu TZ, Lee ZD, Kao CT. Root canal sealers induce cytotoxicity and necrosis. J Mater Sci Mater Med 2004;15:767-71.  Back to cited text no. 10
    
11.
Rölling I, Thulin H. Allergy tests against formaldehyde, cresol, and eugenol in children with formocresol pulpotomized primary teeth. Scand J Dent Res 1976;84:345-7.  Back to cited text no. 11
    
12.
Johannsen FR, Levinskas GJ, Tegeris AS. Effects of formaldehyde in the rat and dog following oral exposure. Toxicol Lett 1986;30:1-6.  Back to cited text no. 12
    
13.
Block RM, Lewis RD, Sheats JB, Burke SG. Antibody formation to dog pulp tissue altered by formocresol uithin the root canal. Oral Surg Oral Med Oral Pathol 1978;45:282-92.  Back to cited text no. 13
    
14.
Yoon RK, Chussid S, Davis MJ, Bruckman KC. Preferred treatment methods for primary tooth vital pulpotomies. A survey. N Y State Dent J 2008;74:47-9.  Back to cited text no. 14
    
15.
King SR, McWhorter AG, Seale NS. Concentration of formocresol used by pediatric dentists in primary tooth pulpotomy. Pediatr Dent 2002;24:157-9.  Back to cited text no. 15
    
16.
Bolt HM. Experimental toxicology of formaldehyde. J Cancer Res Clin Oncol 1987;113:305-9.  Back to cited text no. 16
    
17.
Ranly DM. Assessment of the systemic distribution and toxicity of formaldehyde following pulpotomy treatment: Part one. ASDC J Dent Child 1985;52:431-4.  Back to cited text no. 17
    
18.
Loos PJ, Han SS. An enzyme histochemical study of the effect of various concentrations of formocresol on connective tissues. Oral Surg Oral Med Oral Pathol 1971;31:571-85.  Back to cited text no. 18
    
19.
Primosch RE, Glomb TA, Jerrell RG. Primary tooth pulp therapy as taught in predoctoral pediatric dental programs in the United States. Pediatr Dent 1997;19:118-22.  Back to cited text no. 19
    
20.
Strange DM, Seale NS, Nunn ME, Strange M. Outcome of formocresol/ZOE sub-base pulpotomies utilizing alternative radiographic success criteria. Pediatr Dent 2001;23:331-6.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
Questionnaire 1
References
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