While checking out some dental blogs recently, we ran across this post on a study published last year in Pediatric Dentistry. The researchers looked at the presence of formocresol in the blood of children given pulpotomies.
Formocresol is a solution made of formaldehyde, cresol, glycerin and water, which the dentist applies to a primary tooth when the dental pulpal complex undergoes a necrosis. This happens when the pulp has been exposed for a long time to the toxins of tooth decay. This disease process will damage and ultimately kill the pulp. So to save a deeply decayed primary tooth, the dentist may opt to perform a pulpotomy – a procedure that you can think of as a kind of root canal for kids.
In the most common form of this procedure, formocresol is soaked into a small pellet of absorbent cotton – a pledget – and placed in the tooth for five minutes. After removing the pledget, the dentist usually places a layer of cement called glass ionomer over the openings into the tooth’s root canal and surrounding areas. A composite or amalgam filling is then placed on top.
If the procedure is successful, the remaining pulpal tissue mummifies, just as bodies preserved by the ancient Egyptians mummified.
The idea is to retain the tooth until it exfoliates and the permanent tooth erupts into the dental arch.
Because of the known toxic potential of formocresol, there has been concern about its safety over the years. (This article from the Journal of the Canadian Dental Association gives a good overview of those concerns, as well as alternatives to formocresol.) Thus, studies have been done to assess safety, as well as the efficacy of alternative compounds. The study mentioned above is of the former sort. And it came to the conclusion that because only very low levels are detectable, it is “unlikely” that formocresol poses any risk to children.
But is blood measurement an accurate and comprehensive enough gauge?
When mercury fillings are placed in the teeth, for example, you do not find subsequently high levels of mercury in the blood. Blood will show only recent exposures of a day or two. Yet neurotoxins are definitely in the teeth and expressed into the bone via chewing. To look at only the blood and say there is no toxic risk is a little like saying your lost house keys are not in your home because you didn’t find them in the kitchen.
Though the chemicals from formocresol may be undetectable in the blood, the treated tooth is still non-vital, much like a root canal filled tooth. Both are dead teeth in living mouths and serve as harbors for neurotoxins that pollute the individual’s biological terrain. The denatured protein from the cellular structures in the dentinal tubules – the miles of microscopic tubules that make up the pulp and keep it alive and thriving when healthy – undergo a morphogenesis where the microbes become higher valanced and pathogenic. If you were to remove a pulpotomized tooth and do proper cultures, we would expect to find some very interesting anaerobic characters spewing a variety of neurotoxins such as thioethers and mercapatans – substances that are quite like mustard gas and typically found in cultured root canal teeth.
When it comes to the issue of how to treat deeply decayed primary teeth, we always tell the parents of their array of choices. The two traditional ones are to either remove the tooth and use a space maintainer until the adult teeth come in, or perform a pulpotomy with use of chemicals. However, we have had success with an alternative treatment in which we remove all decay, and if there is some good bleeding from the pulp, we bathe the exposure and surrounding dentin with homeopathic isodes followed by five minutes of soft laser treatment. Then the tooth is restored and the child is given sublingual homeopathic drops to take to promote healing.
We discuss such options with the parents, and their various risks and benefits. We give them resources to help them understand their options as fully as possible. Ultimately, though, as always, the choice is up to them.