A critical review of the current literature concerning preservation of the vitality of the exposed pulp with emphasis on the use of corticosteroids

Abstract

It has been considered for the purpose of this review unnecessary to discuss in detail the Morphology of the dental pulp and dentine, as this may be found in any recognised text-book, but to concentrate on the clinical problems involved. The materials discussed are those in current usage for exposed pulp preservation, whilst other materials may be touched upon and it is the endeavour of the author to review as many results as possible in this field and to draw sound conclusion from statements made. The field of corticosteroids in dentistry is comparatively new and here it is the aim to provide a basis from which further research may be undertaken. Thus, this thesis is divided into two distinct sections. The first section dealing with non-corticoid drugs and the second sections dealing with cortico-steriods and their combinations, exclusively, utilising the commercial product Ledermix as their prime example. However, when considering pulp therapy one must delve into the past to understand the thought and effort that has gone into this realm of dentistry and to note the lack of the true scientific attitude by some into this work. This may then allow us to look again at our own statements to note how much controversy there was, and still is concerning a question such as “should an attempt on the pulp once exposed ever be made to maintain its vitality?” It will be shown at a later stage that the pulp has marvellous recuperating powers if treated in a conservative manner, something which was hardly considered even early this century. Castognola, Quigleyand Berman have all reviewed this subject before. However, my aim is to bring together all of their information as a preface to the important work of considering the immediate study being carried out in this field. The first attempted vital capping was carried out by Philip Pfaff in 1756 with a small piece of gold foil adapted to the base of the cavity. Then in 1826 it was reported that Lenoard Koeker cauterized the exposed pulp with a hot iron wire and placed silver or lead caps over the exposures. It then appeared that little further was written concerning pulp capping until the middle of the 19th century when Albrecht (1856) utilised opiates, caustics and eugenol on the exposed pulp. McKown (1859) recommended cotton soaked in creosote and tannic acid, whilst Taft (1859) was in favour of cauterizing recently exposed pulps with nitric acid and placing a filling immediately. These results were purely a subjective evaluation. In fact Mc Kown’s results were produced on one of his own teeth. The history of pulp preservation really begins in the early 1860’s. Allport (1866) and Atkinson (1866-1868) suggested amputation of all projecting cornua of exposed pulps and placement of a temporary filling until it was healthy. Allport used the b lood clot formed during operation as his means of capping. J Foote (1866) also, believed the blood clot to be the best means of covering the pulp. This certainly appeared to be a reasonable assumption, considering medical knowledge of the day.