Formocresol

Formocresol is indicated for pulpotomy of primary teeth only. It was introduced by Buckley in 1904 and since then a lot of modifications have been tried and advocated regarding the techniques of formocresol pulpotomies.

Composition of Formocresol

Buckley’s Formula

• Cresol – 35 percent
• Glycerol – 15 percent
• Formaldehyde – 19 percent
• Water – 31 percent.

Mechanism of Action

It prevents tissue autolysis by bonding to the proteins. This bonding is of peptide groups of side chain amino acids and is a reversible process accomplished without changing the basic structure of protein molecules.

Histological Changes

• Immediately the pulp becomes fibrous and acidophilic.
• In Seven to fourteen days Three zones appear:

1. A broad eosinophilic zone of fixation
2. A broad pale-staining zone of atrophy with poor cellular definition
3. A broad zone of inflammation extending apically into normal pulp tissue

• In One year: Progressive apical movement of these zones with only acidophilic zone left at the end of 1 year.

Concerns about Formocresol

• Toxicity: Formocresol and formaldehyde have shown to be cytotoxic, mutagenic and carcinogenic in animal experiments by Lewis in 1981. But Ranly calculated that, over 3000 pulpotomies must be performed in the same individual for formocresol to reach toxic level.
• Systemic distribution: Myers in 1978 demonstrated systemic distribution of radioisotope labeled formaldehyde. When used in pulpotomies in animals, labeled formaldehyde has been found in periodontal ligament, bone, dentine and urine.
• Antigenocity: Thoden Valzen in 1977 has shown immunogenic potential of formaldehyde in rabbits, dogs and guinea pigs.
• Mutagenicity and cytogenicity: Nongentini in 1980 postulated that mutational changes were achieved by application of formaldehyde and cytogenicity for 15 minutes, in monkey kidney cells. Formaldehyde denatures nucleic acids by forming methylol derivatives that renders genetic machinery inoperable. It may also effect biosynthesis and cell reproduction by interacting with DNA and RNA. Milnes, 2006 published an extensive and detailed review of the more recent research on the metabolism, pharmacokinetics, and carcinogenicity of formaldehyde and concluded that formaldehyde is not a potent human carcinogen under conditions of low exposure. He concluded that extrapolation of these research results to pediatric dentistry suggests an inconsequential risk of carcinogenesis associated with formaldehyde use in pediatric pulp therapy.

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