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      Mandibular bone necrosis after use of paraformaldehyde-containing paste

      case-report

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          Abstract

          Paraformaldehyde has been used in the past as a pulpotomy agent. However, it has a severe cytotoxic effect and may cause alveolar bone necrosis. Depulpin, a devitalizing agent containing 49% paraformaldehyde, is no longer used frequently due to its severe side effects. In the two cases described in the present study, Depulpin was used as a devitalizing agent during root canal treatment. It caused a gradual loss of sensibility in adjacent teeth, gingival necrosis, and osteomyelitis. This case report demonstrates the serious side effects of using a paraformaldehyde-containing paste as a devitalizing agent for pulp, particularly mandibular bone necrosis.

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          Most cited references19

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          Endodontic anesthesia in mandibular molars: a clinical study.

          Sixty-one mandibular molar teeth with clinically manifest pulpitis, which required endodontic therapy, were studied. Twenty-seven subjects received standard inferior alveolar nerve block (IANB) with 2% lidocaine HCI with 1:100,000 epinephrine and 34 subjects received IANB with 3% mepivacaine with no vasoconstrictor. Pulpal anesthesia was assessed with dichlorodifluormethane (DDM). Subjects who gave a positive response to DDM were given a periodontal ligament injection with 2% lidocaine with 1:100,000 epinephrine. This study showed that 3% mepivacaine HCI is as effective as 2% lidocaine HCI in achieving pulpal anesthesia in mandibular molars with IANB. Of a total 61 IANB with lip anesthesia, 23 subjects required periodontal ligament injection to achieve a negative response to DDM. It was concluded that lip anesthesia is not a reliable indicator of pulpal anesthesia. The use of DDM is a reliable method of determining true pulpal anesthesia.
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            Formaldehyde in dentistry: a review of mutagenic and carcinogenic potential.

            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.
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              Acute pulmonary response of asthmatics to 3.0 ppm formaldehyde.

              Previous studies have failed to demonstrate bronchoconstriction in unselected asthmatics after brief (less than or equal to 1/2-h), controlled exposures to formaldehyde (HCHO). This study was designed to evaluate the acute pulmonary response to 3 ppm HCHO in nine nonsmoking asthmatic volunteers over a more relevant exposure duration (3 hrs). Pulmonary function, nonspecific airway reactivity and symptoms were assessed before and at intervals during the exposure. No significant changes in pulmonary function (FVC, FEV1, FEF25-27%, SGaw, or FRC) or airway reactivity were observed. There was a significant increase in nose/throat irritation at 30 min. (P less than 0.05) and in eye irritation at 60 min (P less than 0.05) and 180 min (P less than 0.01). These results suggest that individuals with asthma will not experience significant bronchoconstriction when exposed at rest to 3 ppm HCHO; however, most will experience eye and upper respiratory tract irritation.
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                Author and article information

                Journal
                Restor Dent Endod
                Restor Dent Endod
                RDE
                Restorative Dentistry & Endodontics
                The Korean Academy of Conservative Dentistry
                2234-7658
                2234-7666
                November 2016
                08 November 2016
                : 41
                : 4
                : 332-337
                Affiliations
                Department of Conservative Dentistry, Wonkwang University School of Dentistry, Iksan, Korea.
                Author notes
                Correspondence to Sujung Park, DDS, PhD. Associate Professor, Department of Conservative Dentistry, Wonkwang University School of Dentistry and Oral Science Research Center, 460 Iksandae-ro, Iksan, Korea 54538. TEL, +82-63-850-6629; FAX, +82-63-859-6932; conspsj@ 123456wku.ac.kr

                Chi-hwan Lee and Yoorina Choi contributed equally to this article as first authors.

                Author information
                http://orcid.org/0000-0003-3457-1242
                Article
                10.5395/rde.2016.41.4.332
                5107436
                27847756
                10fe7cfa-0af7-438b-85ba-c6fce621ca12
                ©Copyrights 2016. The Korean Academy of Conservative Dentistry.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 July 2016
                : 28 September 2016
                Funding
                Funded by: Wonkwang University, CrossRef http://dx.doi.org/10.13039/501100002569;
                Categories
                Case Report

                depulpin,mandibular bone necrosis,osteomyelitis,paraformaldehyde

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