Discussion - References.
Historically, arsenic had an important role in endodontic procedures. In the past, effective anaesthesia was either unavailable or rudimentary and it may have helped in the preservation of many painful teeth. Its use in contemporary dentistry should be avoided, because it no longer has a therapeutic role and has been proven to have many hazardous effects. Since dental students are no longer taught about the use of arsenical compounds, and textbooks warn of their dangers, it is difficult to understand why professionals persist in using them and why they are still available on the market. But they are still in use and dental complications continue to be reported, even in developed countries (Nagle et al. 1980, Stabholz & Blush 1983, Smart & Barnes 1991, Yakata et al. 1985).
Often, the bony destruction associated with these teeth demands extraction (Nagle et al. 1980, Bataineh et al. 1997, Di Felice & Lombardi 1998). But if bone loss is more localized, alternatives may be possible. One involves resection of the adjacent root with maintenance of the entire crown. Application of that approach here allowed a restorable tooth to be preserved as a functional unit, and with no signs of failure for the medium-term. The case will require continued annual review to monitor bony healing and periodontal health. Although our endodontic result would be judged unsatisfactory against European quality guidelines (European Society of Endodontology 1994) and bony healing was incomplete at 1 year, the outcome was satisfactory for the patient and dentist.
Rarely, the consequences of arsenic local toxicity are dramatic. Yakata et al. (1985) described a case in which bony destruction had extended widely, affecting not only the involved teeth, but the entire ascending ramus of mandible, which had to be removed at the time of surgery.
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European Society of Endodontology (1994) Consensus report on quality guidelines of endodontic treatment. International Endodontic Journal 27 , 115-24.
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Nagle G, Woodbury MA, Zenz C (1980) Developments in Occupational Medicine , 1st edn. Chicago, IL, USA: Year Book Medical Publishers Inc.
Smart ER, Barnes IE (1991) Tissue necrosis after using an arsenical endodontic preparation: a case report. International Endodontic Journal 24 , 263-9.
Stabholz A, Blush MS (1983) Necrosis of the crestal bone caused by the use of Toxavit. Journal of Endodontics 9 , 110-3.
Yakata H, Azumi T, Kawasaki T, Nakajima T (1985) Extensive osteolysis of the mandible following devitalization of a tooth by arsenic trioxide. Journal of Oral and Maxillofacial Surgery 43 , 462-5.