Brain injury due to anaphylactic shock: broadening manifestations of Kounis syndrome.

Anaphylactic shock is a real and life threatening medical emergency which is encountered in every field of medicine. The coronary arteries seem to be the primary target of anaphylaxis resulting in the development of Kounis syndrome. Kounis syndrome is a pan-arterial anaphylaxis -associated syndrome affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of mast cell activation disorders. Recently, Kounis-like syndrome affecting the cerebral arteries was found to be associated with mast cell activation disorders. In anaphylactic shock, the decrease of cerebral blood flow is more than what would be expected from severe arterial hypotension. This is attributed to the early and direct action of anaphylactic mediators on cerebral vessels. While adrenaline is a life saving agent in the treatment of anaphylactic shock, it contains sodium betabisulfite as preservative and should be avoided in sulfite allergic patients. Potential allergens encountered in endodotic practice include formocresol, zinc compounds thiurams, sodium dimethyldithiocarbamade, and mercaptobenzothiazole that might have synergistic action. All these agents together with analgesics, antibiotics, antiseptics, formaldehyde, latex, local anaesthetics and metals used in dental practice, in general, can induce anaphylactic shock. Practitioners should be aware of these consequences. A careful history of previous atopy and reactions is of paramount importance for safe and effective management.

The role of bone marrow-derived mesenchymal stem cells in treating formocresol induced oral ulcers in dogs.

BACKGROUND: Mesenchymal stem cells (MSCs), a subpopulation of adult somatic stem cells, are an attractive stem cell source in regenerative medicine because of their multipotentiality. In this study, the effects of MSCs transplantation on oral ulcer healing were examined. METHODS: Mesenchymal stem cells were isolated from bone marrow aspirates of dogs by dish adherence and expanded in culture. Oral ulcers were induced by topical application of formocresol in the oral cavity of dogs. Either autologous MSCs or vehicle (saline) was injected around the ulcer. The healing process of the ulcer was monitored clinically and histopathologically. Gene expression of vascular endothelial growth factor (VEGF) was detected in MSCs by reverse transcription-polymerase chain reaction. Expression of VEGF and collagen genes was detected in biopsies from all ulcers. RESULTS: Mesenchymal stem cells expressed mRNA for VEGF MSCs transplantation significantly accelerated oral ulcer healing compared with controls. There was increased expression of both collagen and VEGF genes in MSCs-treated ulcers compared with controls. CONCLUSION: Mesenchymal stem cells transplantation may help accelerate oral ulcer healing, possibly through the induction of angiogenesis by VEGF together with increased intracellular matrix formation as detected by increased collagen gene expression.

The obsolescence of formocresol.

Concern has existed for almost 10 years regarding the safety and efficacy of formaldehyde-based medicaments like formocresol in dentistry. Formocresol has been shown to be therapeutically outdated for decades. While the use of formocresol around the world continues to drop, it still is utilized in alarmingly high rates, an age-old bias that is unsubstantiated by overall academic research. Formaldehyde remains a genotoxic and carcinogenic problem worldwide. The most recent articles are discussed in light of the need to abandon formocresol.

Iatrogenic trauma to oral tissues.

BACKGROUND: Iatrogenic trauma can be defined as any trauma that has been induced by the dentist's activity, manner, or therapy. The aim of this article is to present traumatic oral tissue lesions of iatrogenic origin. METHODS: Thirteen cases of chemical (due to ferric sulfate and formocresol), physical (due to orthodontic wires and appliances), and thermal (due to electrosurgery) injuries to the oral tissues are reported. RESULTS: Chemical, physical, and thermal injuries in the oral, gingival, or palatinal mucosa of iatrogenic origin can exhibit various clinical features. The management of traumatic injuries is dependent on the severity of the involvement in the periodontal tissues. While, in most cases, the elimination of the offending agent and symptomatic therapy were sufficient, in severe cases, or when the injury resulted in permanent defects, periodontal surgery and regenerative therapy may be necessary. CONCLUSIONS: The skill, experience, and up-to-date knowledge of dentists are the main factors to prevent possible iatrogenic traumas. Although "To err is human," careful practice is very important for the principle "Primum non nocere" ("First do no harm").

Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol.

PURPOSE: The objective of this study was to assess the effect of mineral trioxide aggregate (MTA) as pulp dressing material following pulpotomy in primary molars with carious pulp exposure and compare them to those of formocresol (FC). METHODS: Of 33 children, primary molars treated via a conventional pulpotomy technique were randomly assigned to the MTA group (33 teeth) or FC group (29 teeth). Clinical and radiographic follow-up ranged between 4 and 74 months. The mean follow-up time was 38 months, with no difference between the groups. Twenty-nine teeth were followed until uneventful shedding (mean=33 months). Failures were detected after a mean period of 16 months (range=4 to 30). RESULTS: The success rate of pulpotomy was 97% for MTA (1 failure) and 83% for FC (5 failures). Eight teeth presented internal resorption. In 4 of them (2 of each group), progress of the resorption process stopped and the pulp tissue was replaced by a radioopaque calcified tissue. Pulp canal obliteration was observed in 58% of the MTA group and in 52% of the FC group (total=55%). CONCLUSIONS: MTA showed a higher (though not statistically significant) long-term clinical and radiographic success rate than formocresol, and can be recommended as its replacement as, unlike FC, MTA does not induce undesirable responses.

Periodontal changes following coronal/root perforation and formocresol pulpotomy.

A clinical case report is presented which describes the sequelae of an iatrogenic lateral crown/root perforation and a formocresol pulpotomy. The post-operative course of the initial therapy included significant hard and soft tissue destruction and eventual tooth loss. The possible implication of the role of formocresol is discussed.

Formocresol mutagenicity following primary tooth pulp therapy: an in vivo study.

OBJECTIVES: To investigate whether formocresol, in Buckley's original formulation, is mutagenic in vivo to lymphocyte cultures obtained from the peripheral blood of children aged from 5 to 10 years old. These children were recruited from those attending the dental clinics of Recife City Council and the University of Pernambuco School of Dentistry, Brazil. METHODS: The sample comprised 20 children who had primary teeth with cariously exposed vital pulps. Two venous blood samples were collected (6-8 ml) from each child, the first prior to vital pulpotomy (control group) and the second 24 h after pulpotomy (treated group). This research is a case-control study. The peripheral lymphocytes were grown in a complete culture medium consisting of 78% RPMI 1640 medium (a), supplemented with streptomycin (0.01 mg/ml), penicillin (0.005 ml(-1)), 20% fetal bovine serum (b) and 2% phytohemagglutinin (c). The lymphocytes were assessed for chromosomal aberrations via a previously published method which was modified. The cytogenetic analysis was performed in a blind test, where the slides were codified by an annotator and the scorers did not know which group they were analyzing. For each sample, this envolved the analysis of 200 metaphases. The level of significance adopted in the statistical test was 5.0% (p<0.05). RESULTS: There was no statistically significant difference in clinical doses between the control and treated groups, using Wilcoxon's Signed Ranks test, for the chromosomal aberrations (P=0.251) and for the total chromosomal breaks (P=0.149). Although there were no statistically significant differences between the control and treated groups, Buckley's formocresol was mutagenic for one patient, raising doubt about the desirability of its use for pulpotomies in children. CONCLUSIONS: The results revealed that, from a statistical standpoint, formocresol is not mutagenic. However, further investigations are required, preferably with a larger sample, in patients needing more than one pulpotomy in order to observe whether an increase in the quantity of the drug would increase the quantity of chromosome aberrations and also to verify individual susceptibility to chromosome alterations with the use of formocresol.

Tooth exfoliation and necrosis of the crestal bone caused by the use of formocresol.

A 68-year-old woman received a formocresol pulpectomy of the right lower lateral incisor. The temporary restoration was lost within hours. The next day, the patient suffered continuous pain, the gingiva sloughed, and the alveolar bone was exposed. Four days after treatment, the patient complained of moderate pain. Six days after the pulpectomy, the tooth spontaneously exfoliated. At this time she was referred to our hospital. The clinical diagnosis was chronic alveolitis. Treatment consisted of irrigation of the area. Three weeks after the pulpectomy, the dull pain had subsided, but the alveolar bone of the area showed increased mobility. Five weeks after the pulpectomy, the mobility of the alveolar bone was more significant and a sequestrectomy was performed with the patient under local anesthesia. The sequestrum of necrotic bone was approximately 10 x 5 x 5 mm in size. The patient has been symptom-free for 2 years since the sequestrectomy.

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.

Relationship between formocresol pulpotomies on primary teeth and enamel defects on their permanent successors.

Twenty-five permanent premolars were evaluated for enamel defects. The primary molars that they succeeded had been successfully treated with a formocresol pulpotomy. A relationship between the enamel defects and the pulpotomy procedures has been found.

Histological evaluation of electrosurgery and formocresol pulpotomy techniques in primary teeth in dogs.

The purpose of this study was to compare pulpal and periapical tissue reactions to electrosurgery versus formocresol pulpotomy techniques in the primary teeth of dogs. The study was conducted on 33 primary teeth of three mongrel dogs between the ages of one to three months. Each dog had three teeth treated by Formocresol Pulpotomy with Mechanical Coronal Pulp Removal (FC), three teeth treated by Electrosurgery Pulpotomy with Mechanical Coronal Pulp Removal (ES/MCPR), three teeth treated by Electrosurgery Pulpotomy with Electrosurgical Coronal Pulp Removal (ES/ECPR), and two teeth serving as untreated Controls. Dogs one, two and three were sacrificed performing the pulpotomies at two, four and six weeks, respectively. The pulp, periapical tissue and after surrounding bone were submitted to histological examination and the histological reaction was recorded. The results were fourteen out of 18 unfavorable and zero out of three favorable histological reactions occurred in the FC treated teeth. Six out of 18 unfavorable and one out of three favorable histological reactions occurred in the ES/MCPR treated teeth. Nine out of 18 unfavorable and two out of three favorable histological reactions occurred in the ES/ECPR treated teeth. One out of 18 unfavorable and zero out of three favorable histological reactions occurred in the untreated Control teeth. The conclusion of this study is that of the three experimental groups, the teeth treated by Electrosurgery Pulpotomy with either Mechanical or Electrosurgical Coronal Pulp Removal exhibited less histopathological reaction than the teeth treated by Formocresol Pulpotomy.