Mandibular bone necrosis caused by use of arsenic paste during endodontic treatment: two case reports.

AIM: To report that arsenical pastes are still employed in endodontics and to highlight the potentially serious consequences of their use.

SUMMARY: Chemotherapeutic agents such as arsenic trioxide and paraformaldehyde were once commonly employed as pulp-necrotizing agents. Their cytotoxic effects are well recognized, and leakage from teeth has been associated with widespread necrosis of periodontal tissues and bone. This report describes two cases of severe bone necrosis affecting the mandible following the use of an arsenical paste.

KEY LEARNING POINTS: Pulp-necrotizing agents such as arsenic trioxide can cause severe bone necrosis. Arsenical pastes have no place in contemporary dental practice. Dentists should employ appropriate local anaesthetic techniques for pulp extirpation instead of relying on toxic necrotizing agents.