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 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 Formocresol has been shown to be therapeutically outdated for decades.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.

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 ten 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 is still utilised 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 the light of the need to abandon formocresol.

Randomized controlled trial of mineral trioxide aggregate and formocresol for pulpotomy in primary molar teeth.

AIM: To compare the outcome after 6 months of the application of formocresol (FC) or mineral trioxide aggregate (MTA) during pulpotomy in primary molar teeth. METHODOLOGY: A maximum of 126 children (aged 5-9 years) with carious primary teeth that required pulpotomy were selected. Following randomization, a standard pulpotomy preparation was undertaken, and the coronal pulp removed and bleeding arrested. In the FC group, cotton balls, soaked in FC, were placed for 5 min, and then the pulp chamber was filled with Zonalin, a pulpotomy agent. In the MTA group, a 1-mm-thick paste of MTA was used as a pulpotomy agent. The crowns in both groups were restored with amalgam or glass ionomer. The teeth of 100 patients were evaluated and compared clinically and radiographically after 3 and 6 months. RESULTS: No signs of clinical failure were observed at the 3- and 6-month follow-up appointments in either group. There were no significant differences in the radiographic findings of the teeth and surrounding tissue at the 3-month follow-up. However, at the 6-month follow-up, significantly more cases (P = 0.036) with root resorption were seen in the FC group; no cases of resorption occurred amongst the MTA cases. The surrounding tissue showed radiographic signs of post-treatment disease in four FC cases; none was seen in the MTA cases. CONCLUSION: After 6 months, pulpotomy with MTA was associated with fewer cases of root resorption and post-treatment disease. MTA appears to be a reliable alternative material for pulpotomy in primary molar teeth.

Is there life after Buckley's formocresol? Part II - Development of a protocol for the management of extensive caries in the primary molar.

OBJECTIVE: To produce a working clinical protocol for pulp therapy techniques in the extensively carious primary molar. INTRODUCTION: The International Agency for Research on Cancer has recently classified formaldehyde as carcinogenic to human beings. As such, a medicament that can be used to replace formocresol in clinical practice should be identified. METHODS: Part I of this paper explored the currently available alternative interventions and materials to formocresol in the form of a narrative review following an extensive literature search. Part II now presents the formation of a specialist group to establish an evidence-based protocol, for the management of the extensively carious primary molar. CONCLUSION: A protocol and key points document have been developed to assist clinicians in their treatment planning. Areas for further postgraduate training are identified.

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.