Localized alveolar bone necrosis following the use of an arsenical paste: a case report.

AIM: To describe some toxic effects of arsenic trioxide in the mouth, to condemn its continued use, and present a case in which a tooth was preserved despite significant bony destruction.

SUMMARY: A case is presented in which severe alveolar bone necrosis resulted from leak-age of an arsenical devitalization paste into the periodontium. The tooth was root canal treated before root amputation, and restored with a cuspal coverage restoration. The tooth was observed to be symptomless and functional at the one-year follow-up.

KEY LEARNING POINTS: * Arsenic and its compounds have no place in contemporary endodontics. * Dentists should protect their patients by avoiding the use of arsenic-containing materials and refusing to use products whose constituents are not known. * Localized bone necrosis may not require tooth extraction. Depending on the severity of the case, the tooth may be preserved by a combination of endodontic, periodontal,prosthodontic and maintenance therapies.