In the article, we will consider what role devitalizing paste plays in the world of dentistry.
Devitalization is the killing of the living core (pulp) of the tooth with its subsequent removal. This inevitably leads to death and destruction of the tooth, since the death of the pulp entails the death of the smallest vessels and nerves present in the tooth cavity, which are able to respond to changing conditions.
However, if everything happens this way in wildlife, then in the modern world, where teeth turn into construction objects, the use of the latest dental techniques allows not only to keep the tooth intact, but also to give it the desired shape. And, despite the fact that there is no life in a tooth without a pulp, its physical existence still continues, but only under the condition of constant monitoring and treatment, in case even the most insignificant changes occur in it.
So, the downside of the pulp removal technique is that a tooth left unattended is inevitablewill collapse, and the advantage is that the tooth remains in place, preserved both for chewing and for visual aesthetics.
Devitalizing pastes
Indications for the implementation of devitalization (depulpation) of the tooth are cases when the removal of the pulp is necessary, since it becomes impossible to save it due to the onset of the inflammation process. These are cases of the development of acute pulpitis, provoked by the penetration of infection through the thinned bottom of the carious cavities, through the apical mouth or through the system of microcracks in acute or chronic periodontitis.
When is this procedure needed?
Also, the procedure is performed when opening the pulp chamber with mechanical damage to the tooth or due to inadequate dental interventions. In addition, surgery may be required if it is necessary to prepare teeth for prosthetics, when the likelihood of inflammation under artificial structures should be completely excluded.
Varieties of pastes
The arsenal of dental devitalization products includes:
- depulping pastes that contain arsenic compounds, as well as devitalizing pastes without arsenic, produced on the basis of formaldehyde;
- use of electrochemical pulp necrosis technique.
Despite the pronounced toxic effects of arsenic, the need for accurate dosing and strict adherence to the terms of stay in the pulp cavities of medicines containing it,its use for pulp devitalization is quite expedient and justified by many arguments. Arsenic-based devitalizing pastes kill the pulp very reliably, painlessly and quickly.
Technical features of applying paste
The operation to devitalize the dental cavity consists in applying a paste containing arsenic to the open horn of the pulp, collected on the tip of the probe. This volume is approximately 40 times smaller than a pinhead, based on a maximum single dose of 3mg and a maximum daily dose of 10mg.
After application, the devitalizing paste is covered (without applying pressure) with a piece of cotton soaked in an anesthetic solution. The tooth cavity is covered with a loose dressing made of water dentine, which has a temporary purpose, but ensures the absolute tightness of the tooth cavity. Given the size of the pulp chamber (depending on the number of dental roots), the composition is removed from the cavity after 36 or 24 hours, but if chemical periodontitis occurs, the procedure is performed immediately.
Possible reactive pains
The patient is warned in advance about the likelihood of developing short-term (within 2 hours) reactive pains, and they are offered to alleviate them with Amidopyrine or bromine preparations.
In addition to rapidly passing reactive pains, the use of pastes with arsenous acid compounds threatens to cause severe chemical burns when it is washed out or the cavity is not tight enough, up to necrosis(osteomyelitis). Another consequence of the use of arsenic pastes is the appearance of persistent toxic periodontitis, which is often observed with prolonged and excessive exposure to arsenic.
Thus, in order to avoid periodontal damage with the development of necrosis foci during the use of arsenic, when calculating the dosage and exposure time, the dentist should consider factors such as the patient's age and tooth weight.
Many are wondering what is the effect of devitalizing paste. Scientific studies have shown that the use of adequate dosages of arsenous acid, due to its diffusion into the periapical space, provokes not only the destruction of the dental pulp, but also the stimulation of its stump, and also leads to the regeneration of periodontal tissue.
Are these pastes used for children?
Due to the characteristics of children's teeth with undeveloped and absorbable roots, as well as the child's inability to adequately assess the sensations that arise, the use of devitalizing pastes in pediatric dentistry is contraindicated, phenol-containing preparations are used here, which provide painlessness during pulpectomy.
Composition of these funds
Arsenic acid (As2O3) is present in arsenic-based devitalizing pastes. Arsenic-free pastes that are used for pulp devitalization contain phenol, formaldehyde (formalin) and a combination of their derivatives. In arsenic-free pastes, formalin powder is mixed with creosote, glycerin or petroleum jelly. Their impact is somewhat weaker and less reliable than pastes containing arsenic, and with an insufficient exposure period, instead of necrosis of the dental pulp, only its mummification (sclerosis) can be achieved. However, the purpose of such a manipulation may be just such an effect: with an amputation technique, in the case of dental therapy in children, the sclerotic pulp, which is left in the microtubules, is aseptic and will no longer cause an inflammatory process.
Such devitalizing pastes include Paraform, Paraformaldehyde, Trioxymethylene, Formalin, Asphaline and Triopasta. The last three preparations are based on formalin, however, the use of the latter is more effective in summarizing the results of such a dental procedure, because during therapy with amputation techniques, the pulp stump prevents the diffusion of formaldehyde into the periapical spaces.
The use of, for example, asph alt paste most often leads to the development of reactive periodontitis. During the application of a paste containing paraformaldehyde, lidocaine and phenol, its effect lasts from 5 to 8 days, but it has a milder effect, without irritation and disturbance of periodontal structures. There are no specific features when applying paraformaldehyde pastes - they are the same as for arsenic ones.
Various manufacturers produce both arsenic-free devitalizing pastes, and with arsenic in the composition, which allow not only to achieve the expected effect, but alsoplan a visit to the dental office for the patient. For example, the use of Devit-A paste, which has a pronounced anesthetic effect, helps to relieve severe pain during the treatment of acute pulpitis, Devit-P helps to achieve mummification of the pulp of milk teeth and prevent its extirpation, and Devit-S helps to use method of mortal amputation or exirpation in the treatment of residual symptoms of root pulpitis, both in temporary teeth and in permanent teeth.
Devit Devitalizing Paste
As noted above, this brand of paste is of three types and is used in various dental methods of dental therapy. It is used for pulp devitalization in the treatment of pulpitis during mortal amputation or extirpation, for the treatment of residual pulpitis, and is also used as an additional agent for devitalization during repeated procedures after using devitalizing pastes containing arsenic.
What does Arsenic Free Paste contain?
This Arsenic-Free Paste Contains:
- paraformaldehyde, which is an antiseptic that coagulates albumins and provides pulp devitalization;
- Fibrous filler;
- paste former;
- lidocaine hydrochloride, an anesthetic that reduces the risk of painful symptoms.
The use of Devit pastes provides long-term pulp devitalization without irritation and pain, eliminates the need for re-treatment of canals inin order to neutralize arsenic s alts, as when using arsenic pastes. Pulp devitalization occurs in 3-5 days, sometimes in 7 days. If the patient does not feel pain, sealing can be done already 48 hours after using this devitalizing paste. The effectiveness of this drug is currently the maximum, especially when compared with arsenic-based pastes.
Reviews about these pastes
There are relatively few reviews of devitalizing pastes on medical websites, and they are left mainly by dental specialists who use such drugs in daily clinical practice. Dentists say that arsenic pastes are more reliable, but they are very dangerous for he alth and are not used in the treatment of children's teeth. Arsenic-free preparations such as Devit are the most popular, even though they do not have such power. Nevertheless, according to dentists, they do an excellent job with their main task, and, in addition, they effectively relieve pain, which is very important in dental therapy. To date, they are most often used in dentistry.
