Loss of Three Successional Permanent Teeth Caused by Side Effects of Arsenic Trioxide Used in Primary Molars : A Case Report

According to Sekine') , arsenic trioxide pastes were originally introduced by Spooner2} . It had been widely used for pulp devitalization until the advent of paraformaldehyde by Easlick3) , but this material fell into desrepute because fo undesirable side effects such as interdental necrosis of periodontal tissues which resulted from its incorrect and careless application. This irreversible damage often made extraction necessary, not only for the tooth under treatment but also for the adjacent teeth. Thus it has been emphasized that pastes containing arsenic trioxide should never be used4,s) . Especially in child patiens it is difficult to keep a subsequent appointment within a few days to remove arsenic trioxide applied and to apply with hermetical temporary sealing. Additionally, arsenic trioxide easily diffuses to the surrounding tissues in the furcation of the roots or periapical regions through accessory root canal or root apical foramen enlarged by root resorption. Fortunately, with the advent of effective local anesthetics, pulpectomy has become a relatively painless process, and superseded mummification with the risk of bone necrosis. However, local anesthesia is not always possible in abused child or because the analgesic may not, have worked satisfactorily. Therefore mortal pulpotomy and pulpectomy using paraformaldehyde paste are still performed though infrequently, but use of arsenic trioxide was discontinued in most countries. Regardless of warning on use of arsenic trioxide, unfortunately, we encountered a