Dental iatrogenesis, Part 2.

To substantiate biocompatibility of dental materials and techniques, and thereby reduce iatrogenesis, tests for pulp and dentinal responses have been developed. These have shown that high-speed tooth cutting techniques are superior to low-speed techniques even when both incorporate air-water coolant sprays; pressure when placing restorative materials intensifies pulp responses induced by the cutting procedure, and that chemically self-cured resin composites requiring the application of a matrix to enhance adaptation intensify pulp response as compared to visible light-cured equivalents applied incrementally, fully cured throughout, and not requiring the pressure of a matrix. Most cements are irritating to the pulp when used as luting agents and when used less than 0.5 mm from it. Conditioning agents using weak acids for short periods induce little irritation while bonding agents appear to be beneficial by providing protection from subsequently placed restorative material. Clinicians should make every effort to minimize the development of pulp responses and reduce iatrogenic efforts.