In pediatric dentistry, the selection of restorative and pulpal materials must balance biocompatibility, effectiveness, and safety. Historical materials such as formocresol and dental amalgam have been debated for potential toxicity, while modern alternatives like bioactive cements (e.g., MTA, Biodentine) and adhesive restorative materials are widely accepted.
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✅ Introduction
Dentistry for children and adolescents involves unique biological and behavioral considerations, requiring materials that are safe, effective, and minimally invasive. Materials that were historically part of pediatric practice now face scrutiny due to evolving evidence around toxicity, biocompatibility, and environmental impact. Clinicians must understand both contested and recommended materials to optimize pediatric patient outcomes.
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Dental Article 🔽 Why Formocresol Is No Longer Recommended in Pediatric Pulp Therapy: Evidence-Based Risks and Modern Alternatives ... Current evidence raises serious concerns regarding systemic toxicity, mutagenicity, and potential carcinogenic effects, prompting professional organizations to reconsider its use.✅ Controversial Dental Materials in Pediatric Practice
Formocresol
Formocresol has been used as a pulpotomy medicament in primary teeth due to its bactericidal and devitalizing properties. However, concerns about formaldehyde, a hazardous compound classified as potentially carcinogenic, have led to reevaluation of its routine use in children. Evidence suggests that under low exposure conditions, formaldehyde metabolism may not pose significant carcinogenic risk, yet modern practice favors biocompatible alternatives.
Dental Amalgam
Dental amalgam, an alloy containing mercury, remains controversial due to its mercury content and perceptions of toxicity. Although organizations such as the ADA and FDA acknowledge amalgam’s longstanding safety record, its use in pediatric patients has declined, with emphasis shifting toward resin-based and glass ionomer materials in many programs due to aesthetic and minimally invasive preferences.
Bisphenol A (BPA) Derivatives
Resin-based composites and sealants may contain BPA derivatives, raising concerns about endocrine-disrupting potential. Available evidence highlights transient BPA release after placement, but the clinical benefits of resin-based materials generally outweigh potential exposure when proper techniques are followed.
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Bioactive Cements and Vital Pulp Therapy Agents
Materials such as mineral trioxide aggregate (MTA) and Biodentine have demonstrated favorable outcomes in vital pulp therapy, promoting dentinogenesis and exhibiting high biocompatibility. These materials represent contemporary choices for maintaining pulp vitality in primary dentition.
Glass Ionomer and Resin-Based Restoratives
Glass ionomer cements offer chemical adhesion and fluoride release, aligning with minimally invasive principles, though moisture sensitivity can limit performance. Resin composites provide improved aesthetics and adaptability, yet require optimal isolation for long-term success.
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The transition away from controversial materials like formocresol and amalgam reflects a broader trend toward biocompatible and patient-centered care. While historical evidence attests to the effectiveness of certain legacy materials, modern pediatric dentistry prioritizes bioactivity, regenerative potential, and minimization of systemic exposure. Adoption of contemporary materials should be contextualized within evidence-based protocols and comprehensive risk assessment.
🎯 Clinical Recommendations
▪️ Use bioactive cements (MTA/Biodentine) for vital pulp therapy when indicated.
▪️ Prefer glass ionomer or resin-based restoratives in primary dentition, considering isolation quality and caries risk.
▪️ Avoid routine use of formocresol in pulpotomy unless alternatives are unavailable and benefits outweigh theoretical risks.
▪️ Reserve amalgam for limited situations where other materials are contraindicated, recognizing regulatory and educational trends.
✍️ Conclusion
Controversies surrounding materials in pediatric dentistry have prompted shifts toward safer, more biologically favorable options. Clinicians must remain informed by current evidence when selecting materials for restorative and pulpal procedures. While some traditional materials may still be used judiciously, modern bioactive and adhesive materials represent the safest and most effective choices for pediatric patients today.
📚 References
✔ American Academy of Pediatric Dentistry. (2025–2026). Pediatric restorative dentistry: Pediatric restorative dentistry reference manual. AAPD.
✔ Fuks, A. B. (2015). The use of amalgam in pediatric dentistry: New insights and reappraising the tradition. Pediatric Dentistry, 37(2), 125–132.
✔ Milnes, A. R. (2006). Persuasive evidence that formocresol use in pediatric dentistry is safe. Journal of the Canadian Dental Association, 72(3), 247–248.
✔ Peker, O. (2024). Contemporary dental materials used in pediatric dentistry. Dental and Medical Journal, 6(2), 70–85.
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