Awareness of the Carcinogenic Potential of Formocresol among Dental Practitioners in Pakistan: A Cross-Sectional Study
Article Sidebar
Main Article Content
Abstract
Background: Formocresol remains widely used for pulpotomy in primary teeth despite concerns regarding the toxic and carcinogenic properties of formaldehyde. Objective: To assess the knowledge, awareness, reported practices, attitudes, and perceived barriers of dental practitioners in Pakistan concerning the carcinogenic potential and clinical use of formocresol. Methods: This cross-sectional online survey included dental practitioners from Pakistan. Data were collected from December 2025 to March 2026 using a 21-item self-administered questionnaire and analysed descriptively using IBM SPSS Statistics version 27.0. Results: A total of 208 practitioners participated, including 115 (55.3%) general dentists and 71 (34.1%) house officers. Formocresol was the most commonly reported pulpotomy material among 104 (50.0%) respondents, while 130 (62.5%) recognised its carcinogenic potential. Formaldehyde was correctly identified as the component associated with carcinogenicity by 169 (81.3%); however, only 90 (43.3%) knew its International Agency for Research on Cancer classification. Ninety-two (44.2%) respondents were unaware of the concentration used in practice, and 66 (31.7%) reported never communicating potential risks to patients or parents. Lack of availability of alternatives, habitual training, and cost were reported by 110 (52.9%), 97 (46.6%), and 85 (40.9%) respondents, respectively. Conclusion: Formocresol use remained common despite general awareness of its potential hazards. Greater access to alternative materials, standardised clinical guidance, and focused professional education may support safer and more consistent pulpotomy practice
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
References
1. Issrani R, Prabhu N, Bader AK, Alfayyadh AY, Alruwaili KK, Alanazi SH, et al. Exploring the properties of formocresol in dentistry: a comprehensive review. J Clin Pediatr Dent. 2023;47(3):1–10. doi:10.22514/jocpd.2023.020.
2. Lewis BB, Chestner SB. Formaldehyde in dentistry: a review of mutagenic and carcinogenic potential. J Am Dent Assoc. 1981;103(3):429–434. doi:10.14219/jada.archive.1981.0341.
3. Chandrashekhar S, Shashidhar J. Formocresol, still a controversial material for pulpotomy: a critical literature review. J Restor Dent. 2014;2(3):114–124. doi:10.4103/2321-4619.143594.
4. International Agency for Research on Cancer. Formaldehyde, 2-butoxyethanol and 1-tert-butoxypropan-2-ol. IARC Monogr Eval Carcinog Risks Hum. Vol. 88. Lyon: International Agency for Research on Cancer; 2006.
5. de Alencar Filho AV, dos Santos Junior VE, da Silva Calixto M, Santos N, Heimer MV, Rosenblatt A. Evaluation of the genotoxic effects of formocresol application in vital pulp therapy of primary teeth: a clinical study and meta-analysis. Clin Oral Investig. 2018;22(7):2553–2558. doi:10.1007/s00784-018-2352-y.
6. Leite ACGL, Rosenblatt A, da Silva Calixto M, da Silva CM, Santos N. Genotoxic effect of formocresol pulp therapy of deciduous teeth. Mutat Res Genet Toxicol Environ Mutagen. 2012;747(1):93–97. doi:10.1016/j.mrgentox.2012.04.006.
7. Hamaguchi F, Tsutsui T. Assessment of genotoxicity of dental antiseptics: ability of phenol, guaiacol, p-phenolsulfonic acid, sodium hypochlorite, p-chlorophenol, m-cresol or formaldehyde to induce unscheduled DNA synthesis in cultured Syrian hamster embryo cells. Jpn J Pharmacol. 2000;83(3):273–276. doi:10.1254/jjp.83.273.
8. Abirami K, Ramkumar H, Senthil D. Clinical and radiographic evaluation of the efficacy of formocresol, Allium sativum oil, and Aloe barbadensis gel as pulpotomy medicaments in primary molars: a randomized controlled trial. Int J Clin Pediatr Dent. 2020;13(5):518–522. doi:10.5005/jp-journals-10005-1802.
9. Chauhan SP, Gupta M, Ahmed H, Tongya R, Sharma D, Chugh B. Evaluation and comparison between formocresol and sodium hypochlorite as pulpotomy medicament: a randomized study. J Contemp Dent Pract. 2017;18(11):1029–1033. doi:10.5005/jp-journals-10024-2170.
10. Bashir N, Naz S, Hussain MA, Dastgir R. Comparative evaluation of turmeric extract versus formocresol as pulpotomy agents in primary teeth. Biomedica. 2024;40(4):186–190. doi:10.24911/BioMedica/5-1226.
11. Ramamurthy J, Ganesan B. Use of formocresol by the paediatric dentists across Chennai: a questionnaire study. J Evol Med Dent Sci. 2020;9(39):2884–2888. doi:10.14260/jemds/2020/631.
12. Kaushik P, Kaushik M, Soujanya E, Roshni R, Mehra N, Karthik Prasad L. Knowledge and perception of dental practitioners regarding the use of devitalizing agents. Med Pharm Rep. 2021;94(3):348–352. doi:10.15386/mpr-1820.
13. Baviskar M, Shetty Naik S, Joshi A, Pawar DA. The use of devitalizing agents in primary teeth by pediatric dentists: a questionnaire-based study. Int J Med Sci Curr Res. 2023;6(5):67–73.
14. Selvapriya S, Khandelwal A. Evaluation of knowledge, attitude and practice of final-year and internship students towards the use of devitalising agents in endodontics. J Educ Teach Train. 2022;13(6):273–281. doi:10.47750/jett.2022.13.06.025.