Paracetamol (Acetaminophen) in Pediatric Dentistry: Updated Clinical Uses and Safety Guidelines

Paracetamol (acetaminophen) remains a first-line analgesic and antipyretic in pediatric dentistry due to its favorable safety profile and efficacy in mild-to-moderate pain.

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This article provides an updated clinical review, including pharmacodynamics, pharmacokinetics, indications, dosing protocols, and safety considerations relevant to dental practice.

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✅ Introduction
Pain control in pediatric dental patients is essential for behavior management, treatment compliance, and overall clinical success. Among available analgesics, paracetamol is widely recommended because of its low gastrointestinal toxicity and minimal platelet interference compared to NSAIDs. Understanding its mechanisms, dosing, and risks is critical for safe prescription.

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✅ Pharmacology of Paracetamol

Pharmacodynamics
Paracetamol exerts its analgesic and antipyretic effects primarily through:
▪️ Central inhibition of cyclooxygenase (COX) enzymes, particularly COX-2 in the CNS
▪️ Modulation of the endocannabinoid system
▪️ Activation of descending serotonergic inhibitory pathways
Unlike NSAIDs, it has minimal peripheral anti-inflammatory activity, making it suitable for non-inflammatory dental pain.

Pharmacokinetics
▪️ Absorption: Rapid and nearly complete after oral administration
▪️ Peak plasma concentration: 30–60 minutes
▪️ Distribution: Uniform, with low protein binding
▪️ Metabolism: Hepatic (via glucuronidation and sulfation)
▪️ Elimination half-life: 2–3 hours in children
▪️ Excretion: Renal
A small fraction is metabolized into NAPQI (toxic metabolite), detoxified by glutathione. Overdose increases hepatotoxic risk.

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✅ Clinical Uses and Benefits in Pediatric Dentistry

Indications
▪️ Postoperative dental pain (extractions, pulp therapy)
▪️ Odontalgia due to caries or trauma
▪️ Fever associated with oral infections
▪️ Adjunct to local anesthesia

Benefits
▪️ High safety margin when used correctly
▪️ Minimal gastrointestinal irritation
▪️ No effect on platelet aggregation
▪️ Suitable for medically compromised children (with caution in hepatic disease)

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✅ Recommended Dosage in Pediatric Dentistry

Usual Dosing Guidelines
▪️ 10–15 mg/kg per dose every 4–6 hours
▪️ Maximum daily dose:
₀ ≤60 mg/kg/day (standard recommendation)
₀ Some guidelines allow up to 75 mg/kg/day under supervision

Administration Forms
▪️ Oral suspension (most common)
▪️ Tablets (older children)
▪️ Rectal suppositories (alternative route)
Important: Always calculate doses based on body weight, not age alone.

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✅ Safety Considerations

Adverse Effects
▪️ Rare at therapeutic doses
▪️ Hepatotoxicity in overdose or prolonged use

Contraindications
▪️ Severe hepatic impairment
▪️ Hypersensitivity

Drug Interactions
▪️ Increased toxicity risk with enzyme inducers (e.g., anticonvulsants)
▪️ Caution with combination medications containing paracetamol

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💬 Discussion
Although NSAIDs like ibuprofen may offer superior anti-inflammatory effects, paracetamol remains indispensable due to its excellent tolerability and safety in young children. In pediatric dentistry, it is particularly useful when NSAIDs are contraindicated, such as in children with asthma, bleeding disorders, or gastrointestinal sensitivity.
However, misdosing remains a common clinical issue, often due to caregiver misunderstanding. Therefore, clear instructions and weight-based calculations are essential.

✍️ Conclusion
Paracetamol is a cornerstone analgesic in pediatric dentistry, offering effective pain control with a strong safety profile when used appropriately. Proper dose calculation, caregiver education, and awareness of hepatic risks are crucial for optimal outcomes.

🎯 Recommendations
▪️ Always prescribe weight-based dosing
▪️ Avoid exceeding maximum daily limits
▪️ Educate caregivers about hidden sources of paracetamol
▪️ Prefer short-term use for acute dental pain
▪️ Consider ibuprofen when inflammation predominates, if not contraindicated

📊 Comparative Table: Common Analgesics in Pediatric Dentistry

Drug	Mechanism & Indications	Pediatric Considerations & Limitations
Paracetamol	Central COX inhibition; mild-to-moderate pain, fever	Hepatotoxicity in overdose; limited anti-inflammatory effect
Ibuprofen	Peripheral COX inhibition; pain with inflammation	GI irritation; avoid in renal disease or asthma-sensitive patients
Aspirin	COX inhibition; analgesic and anti-inflammatory	Contraindicated in children (Reye’s syndrome risk)
Naproxen	Long-acting NSAID; moderate pain	Limited pediatric use; GI and renal risks

📚 References

✔ American Academy of Pediatric Dentistry. (2023). Guideline on use of analgesics for pediatric dental patients. Pediatric Dentistry, 45(6), 292–299.
✔ Anderson, B. J. (2008). Paracetamol (acetaminophen): mechanisms of action. Paediatric Anaesthesia, 18(10), 915–921. https://doi.org/10.1111/j.1460-9592.2008.02764.x
✔ Temple, A. R., & Temple, B. R. (2013). Acetaminophen use in children. Pediatrics, 131(5), 1113–1116. https://doi.org/10.1542/peds.2012-3780 Kearns, G. L., et al. (2003). Developmental pharmacology—drug disposition in neonates and infants. New England Journal of Medicine, 349(12), 1157–1167. https://doi.org/10.1056/NEJMra035092
✔ World Health Organization. (2012). WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. Geneva: WHO.

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Oral Contraceptives and Oral Health Effects

The use of oral contraceptives (OCs) has been associated with multiple changes in the oral cavity, particularly affecting gingival tissues, salivary composition, and periodontal health.

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This article reviews current evidence on the biological mechanisms, clinical manifestations, and management strategies related to hormonal contraceptive use in dentistry.

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✅ Introduction
Hormonal contraceptives are widely prescribed for birth control and therapeutic indications. These medications, containing estrogen and/or progesterone, influence systemic physiology and may significantly impact oral tissues. Understanding these effects is essential for optimizing dental diagnosis, prevention, and treatment planning.

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✅ Biological Mechanisms

Hormonal Influence on Gingival Tissues
Estrogen and progesterone receptors are present in gingival fibroblasts and epithelial cells. Hormonal fluctuations increase vascular permeability, promoting gingival edema and inflammatory response.

Alterations in Immune Response
Oral contraceptives may modulate the host immune system, reducing resistance to periodontal pathogens and enhancing inflammatory mediators such as prostaglandins.

Changes in Salivary Flow and Composition
Some studies report reduced salivary flow and buffering capacity, potentially increasing the risk of caries and mucosal alterations.

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✅ Clinical Manifestations

▪️ Gingivitis associated with hormonal changes
▪️ Increased gingival bleeding
▪️ Gingival enlargement (hyperplasia)
▪️ Higher susceptibility to periodontal disease
▪️ Dry mouth (xerostomia)
▪️ Possible increase in alveolar osteitis risk after extractions

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✅ Periodontal Implications
The relationship between oral contraceptives and periodontal disease is influenced by dose and duration of hormone exposure. Modern low-dose formulations present a reduced risk; however, poor plaque control remains the primary modifying factor.

✅ Clinical Management

1. Preventive Strategies
▪️ Reinforce strict oral hygiene protocols
▪️ Encourage use of interdental cleaning devices

2. Periodontal Monitoring
▪️ Regular periodontal evaluation
▪️ Early detection of gingival inflammation

3. Salivary Management
▪️ Recommend saliva substitutes or stimulants if xerostomia is present

4. Dental Treatment Considerations
▪️ Evaluate risk of post-extraction complications
▪️ Consider timing of surgical procedures if indicated

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💬 Discussion
The impact of oral contraceptives on oral health is multifactorial, involving hormonal, microbial, and host-response interactions. While earlier high-dose contraceptives were strongly associated with periodontal changes, contemporary formulations demonstrate lower but still clinically relevant effects. Dentists must adopt an individualized approach, considering patient-specific risk factors such as hygiene, systemic health, and duration of contraceptive use.

✍️ Conclusion
Oral contraceptives can influence gingival and periodontal health, primarily by enhancing the inflammatory response to plaque. Although modern formulations are safer, preventive care and professional monitoring remain essential to minimize oral complications.

🎯 Recommendations
▪️ Maintain optimal plaque control through personalized hygiene instruction
▪️ Schedule regular dental check-ups and periodontal assessments
▪️ Monitor patients with long-term contraceptive use more closely
▪️ Educate patients about potential oral side effects
▪️ Coordinate care with medical providers when necessary

📚 References

✔ Mariotti, A. (1994). Sex steroid hormones and cell dynamics in the periodontium. Critical Reviews in Oral Biology & Medicine, 5(1), 27–53. https://doi.org/10.1177/10454411940050010101
✔ Mealey, B. L., & Moritz, A. J. (2003). Hormonal influences: Effects of diabetes mellitus and endogenous female sex steroid hormones on the periodontium. Periodontology 2000, 32(1), 59–81. https://doi.org/10.1034/j.1600-0757.2003.03206.x
✔ Preshaw, P. M., Knutsen, M. A., Mariotti, A., & others. (2001). Experimental gingivitis in women using oral contraceptives. Journal of Clinical Periodontology, 28(4), 378–384. https://doi.org/10.1034/j.1600-051x.2001.028004378.x
✔ Tilakaratne, A., Soory, M., Ranasinghe, A. W., Corea, S. M., Ekanayake, S. L., & De Silva, M. (2000). Periodontal disease status during pregnancy and 3 months post-partum, in a rural population of Sri-Lankan women. Journal of Clinical Periodontology, 27(10), 787–792. https://doi.org/10.1034/j.1600-051x.2000.027010787.x
✔ Mullally, B. H., Coulter, W. A., Hutchinson, J. D., & Clarke, H. A. (2007). Current oral contraceptive status and periodontitis in young adults. Journal of Periodontology, 78(6), 1031–1036. https://doi.org/10.1902/jop.2007.060276

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Clear Aligners in General Practice: Case Selection & Common Mistakes

Clear aligners have transformed orthodontic care in general dental practice, offering aesthetic and comfortable alternatives to fixed appliances.

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However, appropriate case selection and awareness of common errors are critical for achieving predictable results. This article provides an updated, evidence-based clinical guide.

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✅ Introduction
The increasing demand for esthetic orthodontic solutions has led to widespread adoption of clear aligner therapy (CAT). Advances in digital planning and biomaterials have expanded indications, yet limitations remain in complex tooth movements. General practitioners must integrate diagnostic precision and biomechanical understanding into their workflows.

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✅ Case Selection for Clear Aligners
Proper case selection is fundamental for treatment success.

Ideal Indications
▪️ Mild to moderate crowding (≤5 mm)
▪️ Spacing and minor relapse cases
▪️ Mild Class I malocclusions
▪️ Non-extraction cases with limited tooth movement

Relative Contraindications
▪️ Severe skeletal discrepancies
▪️ Complex malocclusions (e.g., severe Class II or III)
▪️ Significant rotations (>20°)
▪️ Extrusion of teeth (especially anterior)
▪️ Poor patient compliance
Patient compliance is a decisive factor, as aligners require 20–22 hours of daily wear.

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✅ Common Mistakes in General Practice
Despite technological advancements, several errors compromise outcomes:

1. Inadequate Diagnosis
Failure to perform comprehensive assessment (including radiographs and occlusal analysis) may lead to incorrect treatment planning.

2. Overestimating Indications
Attempting complex cases beyond aligner capabilities often results in unfinished treatments or need for refinements.

3. Poor Attachment Planning
Attachments are essential for predictable tooth movement, particularly for rotations and extrusions.

4. Ignoring Interproximal Reduction (IPR)
Lack of proper space management may compromise alignment and lead to suboptimal results.

5. Insufficient Monitoring
Regular follow-up is crucial to detect tracking issues and ensure biomechanical accuracy.

💬 Discussion
The integration of clear aligners into general practice has improved patient acceptance and expanded treatment options. However, clinical success depends on case selection, digital planning accuracy, and adherence to biomechanical principles.
Evidence suggests that while aligners are effective for mild to moderate malocclusions, fixed appliances remain superior in complex movements, such as torque control and significant root positioning.

📊 Summary Table: Brackets vs Clear Aligners

Treatment Feature	Fixed Brackets	Clear Aligners
Aesthetics	Low (visible metal components)	High (transparent and discreet)
Patient Comfort	Moderate discomfort due to wires and brackets	Higher comfort with smooth plastic trays
Treatment Complexity	Effective for simple to complex cases	Best for mild to moderate cases
Oral Hygiene	More difficult to maintain	Easier due to removability
Compliance Requirement	Low (fixed appliance)	High (requires patient adherence)
Treatment Control	High precision in complex movements	Limited in certain movements (e.g., torque, extrusion)

🎯 Recommendations
▪️ Select cases conservatively, especially during early clinical experience
▪️ Utilize comprehensive diagnostic records, including CBCT when indicated
▪️ Plan attachments and IPR carefully based on digital simulation
▪️ Schedule regular follow-ups (4–6 weeks) to monitor tracking
▪️ Educate patients about strict compliance requirements

✍️ Conclusion
Clear aligners are a valuable tool in general dental practice, but their success depends heavily on proper case selection and avoidance of common clinical errors. Dentists must combine digital planning with sound orthodontic principles to ensure predictable and stable outcomes.

📚 References

✔ Rossini, G., Parrini, S., Castroflorio, T., Deregibus, A., & Debernardi, C. L. (2015). Efficacy of clear aligners in controlling orthodontic tooth movement: A systematic review. The Angle Orthodontist, 85(5), 881–889. https://doi.org/10.2319/061614-436.1
✔ Papadimitriou, A., Mousoulea, S., Gkantidis, N., & Kloukos, D. (2018). Clinical effectiveness of Invisalign® orthodontic treatment: A systematic review. Progress in Orthodontics, 19(1), 37. https://doi.org/10.1186/s40510-018-0235-z
✔ Ke, Y., Zhu, Y., & Zhu, M. (2019). A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health, 19(1), 24. https://doi.org/10.1186/s12903-018-0695-z
✔ Kravitz, N. D., Kusnoto, B., Begole, E., Obrez, A., & Agran, B. (2009). How well does Invisalign work? A prospective clinical study. American Journal of Orthodontics and Dentofacial Orthopedics, 135(1), 27–35. https://doi.org/10.1016/j.ajodo.2007.05.018

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HPV and Oral Health: A Comprehensive Guide for Dentists

Human papillomavirus (HPV) is increasingly recognized as a significant etiological factor in oral and oropharyngeal diseases.

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Understanding its clinical presentation, transmission pathways, and preventive strategies is essential for modern dental practice. This article provides a comprehensive, evidence-based overview tailored for clinicians.

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✅ Introduction
HPV is a DNA virus with tropism for epithelial tissues, implicated in both benign and malignant lesions of the oral cavity. The rise in HPV-associated oropharyngeal cancers, particularly linked to high-risk genotypes such as HPV-16, underscores the importance of early recognition and prevention in dental settings.

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✅ Etiology of HPV in Oral Health
HPV belongs to the Papillomaviridae family and comprises over 200 genotypes, categorized into:

▪️ Low-risk types (e.g., HPV-6, HPV-11): Associated with benign lesions such as papillomas.
▪️ High-risk types (e.g., HPV-16, HPV-18): Strongly linked to malignant transformation, especially oropharyngeal squamous cell carcinoma (OPSCC).

Transmission Pathways
▪️ Oral-genital contact (primary route)
▪️ Direct mucosal contact
▪️ Vertical transmission (rare)
▪️ Autoinoculation
Persistent infection with high-risk HPV strains is the key factor in carcinogenesis, mediated by viral oncoproteins E6 and E7, which interfere with tumor suppressor genes (p53 and Rb).

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✅ Clinical Features of Oral HPV Infection
The clinical presentation varies depending on the viral subtype and host immune response.

1. Benign Lesions

Squamous papilloma:
▪️ Exophytic, cauliflower-like lesion
▪️ Common on tongue, palate, uvula
Condyloma acuminatum:
▪️ Larger, multiple lesions
▪️ Pink to white, sessile
Focal epithelial hyperplasia (Heck’s disease):
▪️ Multiple soft papules
▪️ Common in children and adolescents

2. Malignant and Potentially Malignant Lesions

HPV-related oropharyngeal cancer:
▪️ Often located in tonsillar region or base of tongue
▪️ May present with asymptomatic neck mass, dysphagia, or persistent sore throat
Clinical warning signs:
▪️ Non-healing ulcers
▪️ Induration
▪️ Dysphonia
▪️ Unexplained lymphadenopathy
HPV-positive cancers tend to have a better prognosis, yet early detection remains critical.

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💬 Discussion
The increasing prevalence of HPV-related oral diseases reflects changes in sexual behavior and viral epidemiology. Dentists play a crucial role in early detection, particularly through routine oral examinations and patient education.
Despite advancements, challenges persist:
▪️ Lack of routine oral HPV screening protocols
▪️ Limited awareness among patients
▪️ Variability in lesion presentation
Integration of HPV risk assessment into dental practice is essential to improve outcomes.

📊 Preventive Measures: HPV in Oral Health

Preventive Strategy	Clinical Benefits	Limitations
HPV Vaccination	Reduces risk of high-risk HPV infection and related cancers	Limited effect if administered after exposure
Barrier Protection (e.g., condoms, dental dams)	Decreases transmission during oral-genital contact	Not 100% protective due to uncovered areas
Routine Oral Examination	Early detection of suspicious lesions	Requires clinician expertise and vigilance
Patient Education	Promotes awareness and preventive behaviors	Dependent on patient compliance
Smoking and Alcohol Cessation	Reduces co-risk factors for malignant transformation	Behavioral change may be difficult to achieve

🎯 Recommendations
▪️ Incorporate HPV risk assessment into routine dental history taking
▪️ Encourage HPV vaccination, especially in adolescents and young adults
▪️ Maintain systematic oral cancer screening protocols
▪️ Educate patients about transmission routes and preventive measures
▪️ Refer suspicious lesions promptly for biopsy and specialist evaluation

✍️ Conclusion
HPV represents a growing concern in oral and oropharyngeal health, with significant implications for dental professionals. Early recognition, preventive strategies, and patient education are critical components in reducing disease burden. Dentists must remain updated and proactive in addressing HPV-related conditions within clinical practice.

📚 References

✔ Gillison, M. L., Chaturvedi, A. K., & Lowy, D. R. (2008). HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women. Cancer, 113(S10), 3036–3046. https://doi.org/10.1002/cncr.23764
✔ Kreimer, A. R., Clifford, G. M., Boyle, P., & Franceschi, S. (2005). Human papillomavirus types in head and neck squamous cell carcinomas worldwide: A systematic review. Cancer Epidemiology, Biomarkers & Prevention, 14(2), 467–475. https://doi.org/10.1158/1055-9965.EPI-04-0551
✔ Syrjänen, S. (2018). Oral manifestations of human papillomavirus infections. European Journal of Oral Sciences, 126(S1), 49–66. https://doi.org/10.1111/eos.12441
✔ Chaturvedi, A. K., Engels, E. A., Pfeiffer, R. M., et al. (2011). Human papillomavirus and rising oropharyngeal cancer incidence in the United States. Journal of Clinical Oncology, 29(32), 4294–4301. https://doi.org/10.1200/JCO.2011.36.4596

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Iodoform-Calcium Hydroxide Pastes vs CTZ in Pediatric Dentistry

Iodoform-calcium hydroxide pastes have gained attention as a potential alternative to CTZ paste in pediatric endodontics. While CTZ (chloramphenicol, tetracycline, zinc oxide-eugenol) has demonstrated clinical success, concerns regarding antibiotic resistance, cytotoxicity, and regulatory restrictions have prompted the search for safer substitutes.

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This article critically evaluates the benefits, risks, and clinical performance of iodoform-calcium hydroxide formulations compared to CTZ.

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✅ Introduction
The management of infected primary teeth often relies on obturation materials with antimicrobial properties and biocompatibility. CTZ paste has been widely used due to its broad-spectrum antibacterial action, but its composition—particularly chloramphenicol—raises safety concerns.
In contrast, iodoform-calcium hydroxide pastes (e.g., Vitapex®, Metapex®) have emerged as promising alternatives due to their resorbability and favorable biological profile. This article explores whether these materials can effectively replace CTZ in clinical practice.

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✅ Material Composition and Mechanism of Action

CTZ Paste
▪️ Components: Chloramphenicol, tetracycline, zinc oxide-eugenol
▪️ Mechanism: Broad-spectrum antibacterial effect via protein synthesis inhibition
▪️ Limitation: Potential systemic toxicity and antibiotic resistance

Iodoform-Calcium Hydroxide Pastes
▪️ Components: Calcium hydroxide, iodoform, silicone oil (vehicle)
▪️ Mechanism:
₀ High pH (≈12.5) → antimicrobial activity
₀ Iodoform → sustained antiseptic effect
▪️ Advantage: Promotes periapical healing and physiological root resorption

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✅ Clinical Indications and Applications

Iodoform-calcium hydroxide pastes are indicated for:
▪️ Pulpectomy in primary teeth
▪️ Teeth with periapical lesions
▪️ Cases requiring resorbable obturation materials

CTZ is typically used in:
▪️ Non-instrumentation endodontic techniques
▪️ Situations with limited clinical time or patient cooperation

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✅ Benefits of Iodoform-Calcium Hydroxide Pastes
▪️ Superior biocompatibility compared to antibiotic-based pastes
▪️ Resorbability synchronized with primary root resorption
▪️ Reduced risk of systemic adverse effects
▪️ Lower contribution to antimicrobial resistance
▪️ Radiopacity and ease of placement

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✅ Risks and Limitations
▪️ Potential over-resorption before complete root resorption
▪️ Lower immediate antibacterial potency compared to CTZ
▪️ Risk of extrusion beyond apex, although generally well tolerated
▪️ Possible discoloration due to iodoform content

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💬 Discussion
The replacement of CTZ with iodoform-calcium hydroxide pastes reflects a broader shift toward biologically acceptable and antibiotic-free materials. Although CTZ demonstrates strong antimicrobial efficacy, its reliance on broad-spectrum antibiotics is increasingly problematic in modern clinical practice.
Evidence suggests that calcium hydroxide-based pastes provide adequate disinfection while supporting tissue repair and regeneration. However, their clinical success depends on proper case selection and technique, especially in teeth with extensive infection.
Furthermore, the resorbable nature of iodoform-calcium hydroxide pastes aligns well with the physiology of primary dentition, reducing the risk of interference with permanent tooth eruption.

✍️ Conclusion
Iodoform-calcium hydroxide pastes represent a viable and safer alternative to CTZ, particularly in pediatric patients. Although they may exhibit slightly reduced immediate antibacterial activity, their superior biocompatibility, physiological resorbability, and lower systemic risk profile support their preference in most clinical scenarios.

🎯 Clinical Recommendations
▪️ Prefer iodoform-calcium hydroxide pastes in routine pulpectomies
▪️ Reserve CTZ for specific cases where rapid disinfection is critical
▪️ Avoid CTZ in patients with antibiotic sensitivity or systemic risk factors
▪️ Ensure accurate obturation technique to prevent extrusion
▪️ Monitor treated teeth radiographically for resorption patterns

Parameter	Iodoform-Calcium Hydroxide Pastes	CTZ Paste
Composition	Calcium hydroxide + iodoform	Chloramphenicol + tetracycline + ZOE
Antimicrobial Action	High pH + antiseptic effect	Broad-spectrum antibiotic effect
Biocompatibility	High	Moderate to low
Resorbability	Physiological, synchronized with roots	Limited or unpredictable
Systemic Risk	Low	Higher (antibiotic-related)
Clinical Indication	Pulpectomy in primary teeth	Non-instrumentation techniques

📚 References

✔ American Academy of Pediatric Dentistry. (2023). Guideline on pulp therapy for primary and immature permanent teeth. Pediatric Dentistry, 45(6), 384–392.
✔ Coll, J. A., Vargas, K., Marghalani, A. A., Chen, C. Y., & AlShamali, S. (2020). A systematic review and meta-analysis of nonvital pulp therapy for primary teeth. Pediatric Dentistry, 42(4), 256–261.
✔ Siqueira, J. F., & Rôças, I. N. (2019). Present status and future directions in endodontic microbiology. Endodontic Topics, 38(1), 3–23. https://doi.org/10.1111/etp.12264
✔ Subramaniam, P., Konde, S., Mandanna, D. K. (2011). Clinical and radiographic evaluation of metapex in pulpectomy of primary teeth. Journal of Indian Society of Pedodontics and Preventive Dentistry, 29(3), 233–238. https://doi.org/10.4103/0970-4388.85818
✔ Trairatvorakul, C., & Chunlasikaiwan, S. (2008). Success of pulpectomy with zinc oxide-eugenol vs iodoform paste in primary molars: A clinical study. International Journal of Paediatric Dentistry, 18(3), 169–177. https://doi.org/10.1111/j.1365-263X.2007.00914.x

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