For decades, formocresol was considered the gold standard for pulpotomy in primary teeth. Its fixative and antimicrobial properties led to widespread use in pediatric dentistry. However, advances in biomedical research and biocompatible materials have significantly changed clinical practice.
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✅ What Is Formocresol and Why Was It Used?
Formocresol is a compound containing formaldehyde, cresol, glycerin, and water. It was historically used to devitalize radicular pulp tissue in primary teeth.
Its popularity was based on:
▪️ Ease of use
▪️ Low cost
▪️ Short chair time
▪️ Acceptable short-term clinical success
However, success rates alone are no longer sufficient to justify clinical use when patient safety is compromised.
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Multiple studies have demonstrated that formaldehyde can diffuse systemically after pulpotomy procedures. Scientific evidence associates formocresol with:
▪️ Cytotoxic and genotoxic effects
▪️ Immune sensitization
▪️ Potential carcinogenicity
▪️ Adverse effects on developing tissues
The International Agency for Research on Cancer (IARC) classifies formaldehyde as a Group 1 carcinogen, raising major concerns for pediatric patients.
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Leading organizations such as the American Academy of Pediatric Dentistry (AAPD) now recommend biocompatible alternatives over formocresol.
Modern pulp therapy focuses on:
▪️ Preservation of radicular pulp vitality
▪️ Promotion of healing and regeneration
▪️ Use of bioactive and calcium silicate–based materials
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Several materials have demonstrated equal or superior success rates with improved safety profiles:
▪️ Mineral Trioxide Aggregate (MTA)
▪️ Biodentine
▪️ Calcium hydroxide
▪️ Ferric sulfate
Among these, MTA and Biodentine show the highest long-term clinical and radiographic success.
📊 Comparative Table: Pulpotomy Materials in Pediatric Dentistry
| Aspect | Advantages | Limitations |
|---|---|---|
| Formocresol | Simple technique; historical clinical familiarity | Toxicity; carcinogenic potential; not biocompatible |
| Mineral Trioxide Aggregate (MTA) | High success rates; promotes hard tissue formation | Higher cost; longer setting time |
| Biodentine | Excellent biocompatibility; fast setting | Cost; technique sensitivity |
| Ferric Sulfate | Hemostatic effect; acceptable clinical outcomes | Does not promote dentin bridge formation |
| Calcium Hydroxide | Biological compatibility; low cost | Lower long-term success in primary teeth |
While formocresol played an important historical role, its continued use is inconsistent with modern principles of pediatric dental care. Dentistry has shifted from devitalization toward biological pulp preservation.
The availability of bioactive materials that promote dentin bridge formation and pulp healing eliminates the need for potentially harmful medicaments.
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Formocresol is no longer recommended in pediatric pulp therapy due to well-documented systemic and biological risks. Evidence-based dentistry now prioritizes biocompatibility, safety, and long-term outcomes, making modern alternatives the standard of care.
🔎 Clinical Recommendations
▪️ Avoid the use of formocresol in primary teeth
▪️ Prefer MTA or Biodentine for pulpotomy procedures
▪️ Follow AAPD evidence-based guidelines
▪️ Emphasize pulp vitality preservation
▪️ Educate caregivers about safer treatment options
📚 References
✔ American Academy of Pediatric Dentistry. (2023). Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry, 384–392. https://www.aapd.org/research/oral-health-policies--recommendations/pulp-therapy/
✔ International Agency for Research on Cancer. (2012). Formaldehyde. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 100F.
✔ Ranly, D. M. (2000). Pulpotomy therapy in primary teeth: New modalities for old rationales. Pediatric Dentistry, 22(5), 403–409.
✔ Fuks, A. B. (2008). Vital pulp therapy with new materials for primary teeth: New directions and treatment perspectives. Pediatric Dentistry, 30(3), 211–219.
✔ Agamy, H. A., Bakry, N. S., Mounir, M. M., & Avery, D. R. (2004). Comparison of mineral trioxide aggregate and formocresol as pulpotomy agents in primary teeth. Pediatric Dentistry, 26(4), 302–309.
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