ABSTRACT

Background and Objective:

Formocresol is a commonly used pulpotomy agent for primary teeth but concerns about its safety and efficacy have prompted the exploration of alternative treatments. This study aimed to compare the efficacy of turmeric extract and formocresol as pulpotomy agents in primary molars, with the goal of identifying a potentially more effective and safer herbal alternative.

Methods:

This experimental study comprised 54 asymptomatic carious primary molar teeth, divided into three groups according to the time of extraction of teeth: 1 week, 2 weeks and 6 months. Each time-point group contained 18 teeth, which were further subdivided into two subgroups of nine teeth each, based on the pulpotomy agent used: Formocresol or turmeric extract. Teeth were evaluated histologically post-extraction to assess the level of inflammation and dentine bridge formation. Statistical analysis was performed using Fisher’s exact test in statistical software.

Results:

Teeth treated with formocresol showed a higher degree of inflammation compared to turmeric extract over time (p-value = 0.005). In addition, dentine formation was observed in 25%-50% of teeth treated with turmeric extract after 6 months as compared to no bridge formation in teeth treated with formocresol.

Conclusion:

Turmeric extract has potent anti-inflammatory and regenerative effects on the dentine in primary molars compared to formocresol. Being a biocompatible agent, it may be used as an alternative for pulpotomy in primary teeth.

Keywords:

Formocresol, turmeric extract, pulpotomy, primary molars.

Introduction

The pulpotomy procedure involves the removal of the coronal part of the dental pulp that has undergone inflammation or degenerative changes, while preserving the vitality of radicular pulp tissue. This radicular pulp is then covered with a suitable dressing or medicament to promote healing of the amputation site.¹

The dental pulp is unique among human tissues in that it is applied with multiple types of therapeutic agents for healing purposes. Pulp tissue has undifferentiated cells of mesenchyme that can be differentiated into any other types of cells including odontoblasts and fibroblasts, for the repair and protection of the damaged hard tissue of tooth and for the soft tissue of pulp. The ability of stem cells to differentiate and stimulate the formation of cells like odontoblasts more than fibroblasts is a very important step in dentin repair.² Maintaining pulp vitality after any therapeutic procedure is of utmost importance, as this tissue has unique characteristics that are pivotal for the preservation of a tooth.³

Formocresol has been the most widely used pulpotomy agent in primary teeth and considered as ‘Gold Standard’ because of its ease of use and good clinical results.^4,5 Formocresol binds with the protein molecule and prevents tissue autolysis. After formocresol dressing, the radicular pulp undergoes three distinct phases: the coronal third experiences fixation, the middle third of pulp tissue shows the loss of integrity and the apical portion exhibits growth of granulation tissue.⁶ Despite good clinical results, formocresol is known to be mutagenic and carcinogenic and can cause hyperplasia of the permanent tooth.⁷

Herbal extracts have been used for several thousand years in the field of traditional medicine and are increasingly being explored in dentistry for their anti-inflammatory and antimicrobial properties.⁸ Turmeric, known for its anti-inflammatory, anti-carcinogenic and wound-healing properties, has shown promising results as a dental therapeutic agent. It has been used experimentally in endodontics as an intra-canal medicament and antiseptic irrigant.⁹

Recent research indicates a shift from traditional chemically synthesised pulpotomy medicaments toward natural products.¹⁰ Natural product use is increasing owing to their fewer side effects, ease of availability and financial considerations in developing countries.¹¹ For the people of the sub-continent, turmeric is a local product that is easily available, cost effective and has marvelous healing properties. This study aimed to compare the efficacy of turmeric extract and formocresol as pulpotomy agents in primary molars, with the goal of identifying a potentially more effective and safer herbal alternative. The results of this study will help in finding locally available, cost effective, less harmful and natural pulpotomy agent for the preservation of primary teeth.

Methods

This experimental study was carried out at the Pediatric Dentistry Department, de’Montmorency College of Dentistry, Lahore, Pakistan, and Histopathological Laboratory of Postgraduate Medical Institute (PGMI), Lahore, Pakistan, over a period of 12 months (Jan 2019-Jan 2020). The study was approved by the Institutional Review Board of PGMI, Lahore.

A random sampling method was employed to select a sample of 54 patients as the participants of this study. The subject selection included healthy children of 5-9 years old of either gender with prior consent from parents. The inclusion criteria were symptomless carious primary molar teeth having normal physiological mobility and with 2/3rd of the intact root.

While teeth having tenderness upon percussion, or depicting signs of internal/external resorption of root or any malformed teeth with hypoplasia, were excluded.

After selection, clinical evaluations, vitality tests and diagnostic periapical radiographs were performed. Each selected tooth was given local anesthesia and isolated using a rubber dam. Then, cleaning was performed by using 0.2% chlorhexidine solution. For the preparation of occlusal cavities, sterile round diamond bur No.330 was used at high speed, under air water spray coolant. The roof of the coronal pulp chamber was removed by high-speed bur and a spoon excavator was used for cutting off coronal pulp tissue. A moist cotton pellet was placed to control pulpal hemorrhage.

For carrying out pulpotomy procedures, patients were placed into three groups based on the time of tooth extraction. Each group was further sub-divided into two subgroups according to the types of materials used for pulpotomy that is, formocresol (FC group, control group) and turmeric extract (TE group).

Results

Discussion

Maintaining the vitality of the dental pulp is crucial for the long-term viability of teeth, as it enables the pulp to perform essential functions, including dentin bridge formation. The ultimate goal of vital pulp therapy is to regenerate the dentin-pulp complex, ensuring both structural and functional restoration. While histological examination can definitively verify pulp vitality, its practical application in clinical settings is limited. Clinicians often rely on clinical and radiographic evaluations, which may not fully capture the true vitality of the pulp. A tooth is considered clinically successful if it remains symptom-free, responds appropriately to sensitivity tests and exhibits normal radiographic findings.¹⁶

This study aimed to assess the effectiveness of turmeric extract in pulpotomy therapy, comparing it with traditional formocresol. The focus was on evaluating anti-inflammatory, antibacterial and wound-healing effects, positioning turmeric as a natural alternative to a synthetic material.¹⁷

Table 1. Comparison of inflammatory cell response in both groups after 1 week.

^aFisher’s exact test.

Table 2. Comparison of inflammatory cell response in both groups after 2 weeks.

^aFisher’s exact test.

Table 3. Comparison of inflammatory cell response after six months in both groups.

^aFisher’s xact test.

Table 4. Comparison of dentin bridge formation after six months in both groups.

^aFisher’s exact test.

Conclusion

Turmeric extract has shown promising results as an alternative to formocresol in pulpotomy therapy for primary teeth. Its use aligns with the growing interest in natural and biocompatible materials for dental treatments. Further studies are needed to validate these findings and explore turmeric’s potential in broader clinical applications.

Acknowledgement

The authors would like to thank Mr. Waqas Latif, Biostatistician at University of Health Sciences Lahore Pakistan for helping in the statistical analysis of data.

List of Abbreviations

Conflict of interest

None to declare.

Grant support and financial disclosure

None to disclose.

Ethics approval

The study is approved by the Institutional Ethical Committee of Postgraduate Medical Institute Lahore, Pakistan, vide Letter No: PGMI/21-16.

Authors’ contributions

NB: Conception, designing the study content, data collection, investigations and writing.

SN: Supervision, data analysis, critical review and intellectual input.

MAH: Drafting the manuscript, critical intellectual review and acquisition of data.

RD: Writing and drafting the manuscript, acquisition of data, critical intellectual input.

ALL AUTHORS: Approval and responsibility for the final version of the manuscript to be published.

Authors’ details

Nazia Bashir¹, Shazia Naz², Muhammad Asdaq Hussain³, Rabia Dastgir⁴

1. Demonstrator, Department of Operative Dentistry, de’Montmorency College of Dentistry, Lahore, Pakistan
2. Associate Professor, Department of Operative Dentistry, de’Montmorency College of Dentistry, Lahore, Pakistan
3. Lecturer, Department of Conservative Dentistry & Endodontics, National Medical College, Birgunj, Nepal
4. Dental Surgeon, Gulab Devi Chest Hospital, Lahore, Pakistan

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