[Dental Materials In Endodontic Praxis. Ed 1.]
An editorial note:
For readers who don't understand Swedish, this Summary is a substitute. However, there is a lot
more to find. Useful links are the following:
Reference Matrix (In Swedish "Referensmatris")
Here you will find a chart over products, ingredients and literature references for the information
given. Also, there are links to the text for products of which formulations are given.
[A lexical register over ingredients in root filling materials.] (In Swedish "Lexikalisk
Should be self explanatory.
[Cross references for synonyms.]
Includes English and Latin names. (In Swedish "Korsreferenser")
In this section you find all the names of ingredients including synonyms with links to the register
[References.] (In Swedish "Referenslista")
On this page you find the links above in the margin, and in English. The Swedish names are in the
margins of all other pages, so they are given to help navigating.
This is important information for
consumers, because producers, authorities, and dentists will not give full information. In this
context also the dentist is to be regarded as a consumer, because he or she will not know the full
contents of the ingredients used. Some because traders and producers do not want to tell, some hidden
as trade secrets. All of course for the patient's safety, a peculiar use of the precautionary
principle. The article has been on the Internet before, but the link has been broken. It's a pleasure
to make it available again.
The overwhelming majority of all root canal fillings in Sweden today are
made with gutta-percha. A number of different gutta-percha brands contains
0,6-0,7% cadmium, probably due to cadmium-based color pigment.
Cadmium-pigments are prohibited in Sweden since 1982. In a special
regulation the Naturvårdsverket has made an exception for dental
materials. In this kind of endodontic therapy based on gutta-percha,
chloroform is used both as an ingredient in a so called sealer and as a
solvent for the gutta-percha itself. No drugs sold in Sweden contains
chloroform. In the USA the use of chloroform is prohibited in both drugs
an cosmetics due to its cancerogenity.
Compared to the situation in the 1950'ies, 1960'ies and partly the
1970'ies a considerable improvement has taken place in the use of dental
materials and intra-canal medication in endodontic therapy. Among the
patients there are however those who have root canal-fillings performed
with materials and methods common in those days. It is appropriate that a
report dealing with ingredients in endodontic materials should take into
account fillings that actualy are placed in the teeth of the patients
today, even though the number of fillings from the beginning of the period
are relatively few. The majority of the root canal filling materials
studied are described in scientific litterature within the last ten years.
Devitalizing-, sterilizing- and irrigation agents used temporarily in the
beginning of the therapy before the permanent obturation of the root canal
has also been studied.
Among the ingredients in preparations used as root canal filling-materials
described in scientific litterature from the 1950'ies and onwards we have
found: Asphalt, benzine, lead oxide, phenol, phenylmercuy, formaldehyde,
cadmium, creosote and others. In devitalizing agents arsenic, phenol and
cocain has been used.
A considerable number of ingredients in preparations used as root canal
filling materials has also been used in the manufacturing of paints,
lacquers and varnishes. Among these ingredients also used in the
paint-industry we have found alum, arsenic trioxide, lead oxide, resin,
champhor, Canada balsam, bismuth carbonate and others. Other ingredients
has been used as pesticides and fungicides because of their strong
biological activity: Arsenic trioxide, dichlorophene, 8-hydroxyquinoline
and tricresol. Today, a number of the ingredients found are regarded as
Several modern dental materials, among others glass-ionomer cements,
contain substantial amounts of fluoride. Due to the instability of these
materials an intensional and prolonged release of fluoride ions takes
place in order to reduce the incidence of caries. Fluoride containing
pastilles and rinsing agents are regulated in the drug act whereas the use
of fluoride leaching dental materials are unregulated.
One root filling material, N2, has been used in a very large scale despite
the fact that it has been illegalized and the use has been declared not to
conform to acceptable treatment standards. A society, the Swedish
Endodontic Society, SES, has been formed in order to promote the use of N2
in opposition to the regulations and regardless of the scientific evidence
showing adverse effects. The Socialstyrelsen has for a long period of
time, despite detailed information on the misuse of N2, omitted to take
powerful action against the cement. Since 1958 when the N2-method was
introduced in Sweden, 1.5 - 2 million root canals has been treated with N2.
Approximately 50 % of all root canal treatments results in over-filling.
This means that the filling material is forced out of the root and into
contact with the surrounding tissue. Convincing scientific evidence has
shown that these overfillings are gradualy resorbed and spread
The problems with the bicompatibility of dental materials has been
identified. Biological testing of dental materials has begun. The need for
biological testing only applies to new materials however. Old, well
established materials dealt with in this report will in practice not have
to be tested.
At the opening of the EC's single market in 1992 there will be a new set
of standards for dental materials. The work with these are under way at
CEN. These standards will apply to both EC- and EFTA-countries which means
that Sweden will be affected to a great extent. Sweden is not
participating in this work and will not have any influence on the
standards for biological testing of dental materials after 1992 unless big
efforts are made within a very near future.
Neither central registration of adverse effects nor licensing of dental
materials are conducted in Sweden at present. According to a regulation
from the Socialstyrelsen information on both type of dental material and
manufacturer has got to be entered in the patients case-book. Any adverse
effect or suspected adverse effect has also got to be recorded.