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European Journal of Paediatric Dentistry 2002 Number 3 Volume 3 September

EDITORIAL EJPD 2002; Sep 3(3):109-110 Proper function of primary teeth is essential to the well being of children and a sound and healthy set of teeth should be the aim of all parents and the dental profession. It is unfortunate, as we know only too well, that dental caries continues to be a major problem for children worldwide. It would be nice to think that all children could grow up to adulthood with a perfect set of teeth, but the reality is that for a percentage of our children dental caries seriously affects primary teeth with the consequences of discomfort, pain, abscesses and extractions. While many teeth can be restored to full function with simple restorations, others require more complex attention involving pulp therapy. Approaches to the treatment of infected pulps in primary teeth have been extensive and highly variable. This is not a new phenomenon as a search of the literature shows that from the mid 18th century dentists were trying, in an empirical way, various chemicals and medicaments to fix or kill off infected pulp tissue in children's teeth. Such treatments included very corrosive chemicals such as sulphuric, nitric or carbolic acids, metals such as gold, arsenic and mercury as well as compounds like red lead, calomel or copper oxide. Indeed, just about everything available was used. Mechanical approaches by extirpating pulp tissue and filling with beeswax, amalgam or melted lead were all used. The trauma to the children of those times must have been awful. It was not until the publications of Dr Sweet (formocresol) and Professor Tovrud (Tovrud's Paste) that a more scientific approach was taken to develop agents that would mummify any intercoronal or interradicular tissue. Subsequently various studies claimed success for these agents. Over more recent years the use of dilute formocresol has become the standard approach to pulp therapy although other agents, such as calcium hydroxide, for which there is evidence of efficacy, continue to be used. Even so, other agents, for which there is no evidence of efficacy, have been used purely by custom and habit, such as beechwood creosote. Accordingly, this issue of our journal focuses on primary tooth pulp treatments and on which medicament should be used for pulp therapy. In a series of four papers, presented at the Congress of the EAPD in Dublin, earlier this year, the merits of several agents are discussed and the research evidence for their use presented. Other papers on pulp therapy are also included so that the focus of great part of this issue is on this topic. This is an important development that should be of great interest to all our readers. In these days of evidence-based dentistry we should only be using agents for which there is proven effectiveness. Such evidence must be based on properly conducted clinical trials over a sufficient period of time to demonstrate clinical usefulness. In this regard I would suggest that success rates be reported for a minimum of 36 months, if not 60 months. After all, for most children we would want any treated primary teeth to remain in the mouth until the normal time of exfoliation, that is for a 3 year old until aged 9 years. Preservation of primary teeth can be readily accomplished by the use of pulp therapy, and this should be a standard treatment of every dentist who cares for children.

Martin Curzon

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