Sir, I am writing to contribute to the debate on formocresol use in children for primary molar pulp therapy in response to recent letters.1,2

Formocresol has been used for many decades in paediatric dental practice and beyond doubt has been one of the most successful pulp medicaments. Moreover, seldom have any side effects or toxicity been reported that have arisen out of its clinical use. However, there are questions about the safety, about the chemicals that constitute this therapeutic material, in particular formaldehyde and cresol, albeit in concentrations far in excess of what is present in the solution for dental use. It is unthinkable that any such chemicals with even a remoter link to any toxicity will ever be allowed to be used in any other surgical practice in children and it seems to be a matter of time before the authorities will clamp down on the use of formocresol in dentistry.

In addition there are alternatives that have been shown to be as efficacious and so far with no toxicity. In a prospective randomised control trial comparing formocresol with ferric sulphate, the only such well conducted study, a comparable efficacy was reported for formocresol and ferric sulphate.3 There are a number of other studies, although not as well conducted, which lead to the same conclusion. In addition I also question whether a fixative is required on radicular pulp that is not usually irreversibly inflamed and is also adequately perfused, adding to its healing potential.4 Given this body of evidence for ferric sulphate, I see no reason to dig my heels in and defend formocresol, which in my opinion now has a shadow cast over it and its reputation has been forever tainted. It is the responsibility of clinicians who are advocates for children, to make sure what we use is efficacious and free from any links with potential toxicity, and given a perfectly suitable alternative in ferric sulphate, it is perhaps time we should consider giving formocresol up. I therefore concur with views expressed by Dr Mike Casas from Toronto that the use of formocresol is unwarranted in paediatric dentistry.5