Devit-S (potent paste) (3g)

Arsenic devitalizing paste consists of the following components:

Arsenic anhydride.
Elements that have an antiseptic and disinfecting effect on the pulp.
Pain relieving components.
Components that ensure long-lasting action of the paste.
Additional components.

Arsenic in any form is one of the most potent poisons. A dose of 5 mg is toxic for humans, and therefore for devitalization the permissible maximum dose is 3 mg.

If the dose is exceeded, symptoms of intoxication such as vomiting and loose stools may occur.

When arsenic paste is applied to the pulp, gradual necrosis of nerve endings and blood vessels occurs. Since the blood supply is cut off, the pulp dies and the transmission of nerve impulses stops.

Many dentists prefer not to use arsenic paste for devitalization, especially when treating children, pregnant and nursing mothers. Moreover, there are safer and less toxic analogues.

History of the creation and use of arsenic paste in dentistry

M. A. Egorova, student of the State Educational Institution of Higher Professional Education "Kazan State Medical University" of Roszdrav, Department of Therapeutic Dentistry

L. R. Mukhamedzhanova Doctor of Medicine, Associate Professor, Head of the Department of Therapeutic Dentistry, Kazan State Medical University, Roszdrav, Department of Therapeutic Dentistry

More than four centuries ago, the German alchemist, philosopher and occultist Theophrastus Guggenheim, known as Paracelsus, proposed the use of arsenic and its compounds to treat various diseases. From this time on, perhaps, the difficult “medical fate” of arsenic compounds, full of dramatic moments, began. At the same time, their biological effects are being actively studied. Already by the middle of the 17th century, prescription recipes were developed that included arsenic acid and were intended for the treatment of blood diseases, infectious diseases, etc. Dentists did not stand aside, for whom the problem of anesthetizing the inflamed pulp was a kind of “pain point”.

Modern specialists involved in endodontics use numerous arsenic preparations to devitalize the pulp, while opinions about the advisability of their use are often diametrically opposed. Therefore, it seems to us very relevant to study the historical aspects of the creation and use of arsenic paste in dentistry.

The material for the study was excerpts from dental manuals of the 17th-20th centuries and a historiographic description of the development of dentistry.

Analysis of the source base suggests that arsenic was used in the treatment of damaged teeth around 500 BC. e., as recorded in the book of Zhu-Qing. However, after this and until the 19th century, no further mentions have been found. In the first half of the 19th century, the ideas of J. Hunter finally began to be realized: attempts were made to remove the pulp with a thin serrated instrument after cauterizing it with acid. The nerve was removed with a trephine, needles, or a special hand-held trocar instrument. The pulp continued to be cauterized for the purpose of preliminary anesthesia for such interventions. However, at the same time, a tool was introduced into endodontic practice that significantly changed its character: in 1836, the American dentist Shearjashub Spooner, in his work “The Path to Healthy Teeth, or a Popular Treatise on Teeth,” described a method of “killing the nerve” with arsenic acid (albeit without its subsequent removal). It was recommended to mix arsenous acid with morphine sulfate. Today this fact will seem surprising to us, since in the times described there were no restrictions on the use of narcotic analgesics. In 1872, in the article “What shall we do with a baby tooth in which the pulp is subject to decay?” (“What shall we do with deciduous teeth in which the pulps are exposed?”) it was proposed to apply an arsenic drug, followed by removal of the coronal pulp and filling the cavity of the temporary tooth. The author considered it necessary to warn parents about the possibility of “... the development of periostitis, then alveolar abscess,” after which (!) “no serious problems arise.” German scientist Ad. Witzel (1874) notes that the use of arsenous acid “created a new stage in the study of dental diseases.”

The practical use of arsenic paste is described by Yu. Sheff in the “Manual of Dental Diseases” (1882). To eliminate toothache, he suggests using arsenic paste and carbolic acid. Gives several recipes containing narcotic analgesics for local anesthesia in direct contact with the exposed pulp: tincture of opium; tincture consisting of morphine, alcohol and chloroform; pills containing creosote. After preparing the latter, it was recommended to “put it on cotton wool on the painful cavity.”

J. Parreidt (1890) suggests using arsenic paste for pulp inflammation and also as an anesthetic: “Remove the filling, cauterize and scrape out the tooth pulp.” For cauterization, the author recommends arsenic, to which a small amount of carbolic acid is added; iodoform is used instead of morphine. Parreidt used a cauterizing agent with the following composition:

Rр. Acid. arsenicosi.
Pulv. Jodoform. pur. alcoholisat.
Acid. carbolic. pur. ana.

For the first time, restrictions on the use of arsenic acid were introduced only in 1898 by WD Miller in a manual on conservative dentistry. He pointed out that “... arsenous acid should not be used in children, their teeth are usually too rotten and soft, and the foramen apicale is mostly too wide, or part of the root apex has already been reabsorbed. Under such conditions, it can easily happen that the arsenic paste will have an effect on the root sheath.” The next blow to the use of arsenic paste came from the Board of Drugs of the American Dental Association (Ada, 1961). The main disadvantage of “irreversible devitalizing anesthesia” is the toxic effect on the periodontium. Due to the technical complexity of dosing, the likelihood of periodontal damage is very high. In addition, the carcinogenic effect of arsenic drugs did not lose relevance.

In the 20th century, arsenous acid (anhydride) began to be used in the form of a paste. To formulate the paste, medicinal substances with anesthetic and antiseptic properties were added to the acid, as well as agents that slow down the diffusion of arsenic into the pulp tissue and thereby weaken its toxic effect. For this purpose, novocaine, carbolic acid, tannin, iodoform, clove, camphor oils, and glycerin were used. E. M. Gofung and I. G. Lukomsky (1936) recommend adding tannin and cinnamon oil to the arsenic paste, which simultaneously promotes mummification of the cauterized pulp. The presence of morphine or cocaine in the paste is designed to make the pulp less sensitive during the devitalization process, but many consider their effect to be very questionable. Adding creosote or carbolic acid to the paste causes a burn of the pulp followed by a scab and interferes with the rapid absorption of arsenic.

The literature mentions the use of tiled arsenic for pulp devitalization. Its effect is gentler than arsenic, and most importantly, it does not cause complications on periapical tissues. However, tile arsenic is nothing more than cobalt, the action of which is fundamentally different from the action of arsenous acid.

In 1927, Mủller made an extraordinary instruction: “...pulps extirpated after devitalization with arsenic paste turned out to be sterile.” This new circumstance significantly increased the value of arsenic. However, today it is known that arsenic itself does not have bactericidal properties. The substances that make up the arsenic paste are important here: phenol, creosote, etc.

Considering that arsenous acid is a strong protoplasmic poison, it is necessary to strictly adhere to the dosage of the paste depending on the size of the tooth, the condition of the pulp, the age of the patient and the choice of treatment method for pulpitis. However, the dosage of arsenic paste caused a lot of controversy. Later they came to the conclusion that it is enough to leave 0.0002-0.0004 g of arsenic acid in single-rooted teeth for 24 hours, and in multi-rooted teeth for 48 hours. One of the main conditions for applying the paste is direct contact with the pulp tissue. A. I. Rybakov (1980) about.

To date, the mechanism of action of arsenous acid on pulp has been studied in detail. Being a protoplasmic poison, arsenous anhydride primarily affects the oxidative enzymes of the pulp, leading to local disruption of tissue respiration and hypoxia. Under the influence of even the smallest amount of arsenic, the oxidase loses its specific functions as an oxidation enzyme. In addition, arsenic blocks thiol compounds that function as respiratory coenzymes. The symptom complex of the effect of arsenic on the pulp is characterized by changes in the vascular system. Already 2-2.5 hours after the start of devitalization, hyperemia develops, the vessels, especially the capillaries, are sharply dilated, then numerous hemorrhages appear, which depend on changes in the walls of the vessels and the loss of their resistance. Swelling causes compression of the pulp tissue. The nerve fibers of the pulp undergo granular disintegration of the myelin sheaths, nodular swelling and disintegration of the axial cylinder. Varicose nerve fiber is replaced by its death. Changes in all groups of cellular elements of the pulp come down to the phenomena of karyorrhexis and cell death, primarily odontoblasts. The depth of pulp damage is directly related to the duration and dose of arsenous acid. At the site of application of arsenous acid, a picture of the death of all elements of the coronal pulp is observed.

As for those cases when arsenic paste does not have a sufficient effect, they are explained by the presence of denticles in the pulp, which do not allow arsenic to pass through themselves and are an insurmountable obstacle for it. In such cases, E.M. Gofung and I.G. Lukomsky (1936) recommend removing the denticles and reapplying the arsenic paste.

Successfully performed devitalization ensures demarcation between the necrotic pulp and the periodontium, resulting in the creation of conditions for the release of the pulp from the canals with minimal bleeding and, consequently, for the healing of the surgical wound after extirpation.

Currently, a huge number of dosage forms intended for professional use in dentistry are appearing on the domestic and foreign pharmaceutical market. And arsenic preparations for pulp devitalization also did not go unnoticed by the research laboratories of leading enterprises producing dental materials. Arsenic paste began to be produced in doses, in the form of granules of various colors, depending on the required timing of application of the paste (green, blue, etc.). Sometimes a filler in the form of threads of different colors (or cotton wool) is added to the arsenic paste for the correct dosage, which greatly facilitates their use in various clinical situations.

Thus, based on an analytical review of literature sources, we consider it appropriate to distinguish three stages in the history of the use of arsenous anhydride in the treatment of pulpitis. The 1st stage (500 BC - the beginning of the 19th century) is characterized by the use of arsenic anhydride without the addition of narcotic analgesics, antiseptics and consistency substances. At the 2nd stage (mid-nineteenth century - mid-twentieth century), arsenic anhydride is included in multicomponent pastes containing analgesics, mummifying drugs, and consistency substances. The 3rd stage (from the mid-twentieth century to the present) is characterized by the use of dosed, prolonged preparations, allowing for an individual approach to dose selection and determining the duration of the period of pulp devitalization.

Baume R. Guide to dental diseases / R. Baume. - M.: 1897. - P. 321.
Gofung E. M. Clinic of diseases of teeth and oral cavity. Guide for doctors and students / E. M. Gofung, I. G. Lukomsky. - State Medical Publishing House of the Ukrainian SSR, 1936. - pp. 360–388.
Ivanov V. S. Practical endodontics / V. S. Ivanov, G. D. Ovrutsky, V. V. Gemonov. - M.: Medicine, 1984. - P. 82, 145.
Rybakov A.I. Clinic of therapeutic dentistry. 2nd ed. / A. I. Rybakov, V. S. Ivanov. - M.: Medicine, 1980. - 318 p.
Stolyarenko P. Yu. History of pain relief in dentistry (part 1). Monograph / P. Yu. Stolyarenko. - Samara, 2001. - pp. 66–78.
Khomenko L. A. Medical interventions in the root canals of temporary teeth. Part 1. To treat or not to treat?/L. A. Khomenko, N.V. Bidenko, A.I. Zelenkova // Modern dentistry. — 2008, No. 1 (41). — P. 99–109.
https://www.krugosvet.ru/enc/nauka_i_tehnika/himiya/MISHYAK.html
https://www.dentoday.ru/ru/content/archive/2001/11/14/
https://biodent.com.ua

Side effects that may appear after using arsenic paste:

If the dosage is exceeded, signs of intoxication of the body may appear - nausea, vomiting, diarrhea.
If the paste is applied poorly, it may be washed out or leaked, accompanied by a burn of the oral mucosa with subsequent complications.
If the paste is kept in the tooth cavity longer than intended, the dentin may change its color - turn black.
Due to the high toxicity of the paste, periodontitis may begin.
Swelling of the pulp due to inflammation.
The effect of the poison can spread to bone and periosteal tissue, causing their destruction.

Paraformaldehyde paste - mechanism of action, advantages of use

Paraformaldehyde paste is applied to the tooth for a longer period than arsenic paste. Instead of wearing arsenic paste for a maximum of 48 hours, the patient should undergo paraformaldehyde for 10-14 days. However, this method of devitalization is considered more gentle on the body, since this paste is less toxic. It does not have such an aggressive effect on periodontal tissue as does containing arsenic. This paste promotes the death of pulp vessels and the cessation of its blood supply, but does not cause pathological changes in the periodontium even with prolonged use.

Paraformaldehyde also has a mummifying effect on dying pulp. It “pulls” moisture from the pulp, causing it to dry out.

If it is necessary to devitalize the pulp of a tooth with unformed roots, use only paraformaldehyde paste.

Devit-S (potent paste) (3g)

DEVIT - S - POWERFUL DEVITALIZING PASTE WITHOUT ARSENIC

PURPOSE

Paste "Devit-S" is used for pulp devitalization in the treatment of pulpitis using the method of mortal extirpation or amputation, for the treatment of residual root pulpitis of temporary and permanent teeth, and also as an additional means for devitalization during a repeated procedure after the use of pastes containing arsenic.

BASIC PROPERTIES

Arsenic-free paste "Devit-S" contains:

paraformaldehyde is an antiseptic that coagulates albumin, providing pulp devitalization;
lidocaine hydrochloride, which is a local anesthetic and reduces the risk of painful reactions;
creosote is an antimicrobial component;
paste former and filler, giving the paste a fibrous structure.

The use of Devit-S paste ensures prolonged devitalization of the pulp with virtually no irritation and pain, and also eliminates the need for additional treatment of the canals to neutralize arsenic salts, as is the case with the use of arsenic pastes.

MODE OF APPLICATION

Clean the cavity from carious dentin and open the pulp chamber.
Introduce the required amount of paste using a probe (without pressure) into a well-opened (or open) cavity. In case of significant necrosis of the pulp surface, it is necessary to remove part of the necrotic pulp under application anesthesia.
The amount of paste is determined individually.
When treating pulpitis of baby teeth, as well as single-rooted teeth in adults, it is enough to apply the paste in an amount equal to the size of millet grain.
To devitalize the pulp of multi-rooted teeth, the amount of paste must be doubled.
After applying the Devit-S paste, it is necessary to hermetically close the cavity with a temporary filling material (water-based Dentin powder).
Complete devitalization of the pulp occurs in 3-5 days, in rare cases - in 7 days.
If the patient does not feel pain, permanent filling can be performed within 24-48 hours after applying the paste.
If direct contact with the pulp is not achieved, devitalization must be carried out in two stages. Direct contact can only be achieved in the second stage after pulp viability has decreased.
After devitalization and extirpation of the pulp, instrumental and medicinal treatment of the canal is necessary (a set of EndoZhi fluids).

Precautions: The patient should be instructed to immediately seek medical attention if they experience a creosote taste in the mouth, which indicates leakage of the devitalizing paste through the temporary filling.

Note: The drug is contraindicated for persons with hypersensitivity to paraformaldehyde. If pulpal pain intensifies after applying the paste (the pulp horn is not exposed or the paste is applied very tightly), it is necessary to perform infiltration anesthesia with lidocaine.

RELEASE FORM

Paste (syringe) - 3.0 g

STORAGE CONDITIONS Store in a dry place, protected from direct sunlight, in a tightly closed container, at a temperature from +5°C to +20°C. Seal tightly after each use.

Shelf life – 2 years.