Corticosteroids in dentistry.

The application of corticosteroids to cut dentine following cavity preparation, to carious dentine in indirect pulp capping, to the exposed pulp or to pulp remnants and periapical tissues during root canal therapy has been claimed to eliminate post operative pain and inflammation. Other investigators have thrown doubt on the validity of these claims and have reported continued inflammation progressing to necrosis following such applications. This paper reports detailed clinical and histological findings in a series of over 500 teeth some of which received conventional treatment while others were treated with various corticosteroids including Mosteller's solution, tritiated prednisolone, and Ledermix paste and cement. The results confirm the fact that no clear correlation exists between symptoms and histological findings in pulp disease. The absence of pain following application of corticosteroids cannot therefore be taken as evidence of a specific therapeutic effect. In some cases pain returned after a period and histologic examination showed the slow development of inflammatory changes coupled with calcification in pulp tissue and on the walls of the canal. Further investigation is needed to clarify the relative contribution of the removal of toxic products by instrumentation and the anti-inflammatory properties of corticosteroids in the reduction of pain of pulpal origin.