Sir, I write with reference to the letter by H. Al-Saffar and D. Dadnam regarding the use of Odontopaste as an alternative to Ledermix in children.1

Both medicaments have been shown to provide symptomatic relief in the management of pulpal symptoms, eg irreversible pulpitis and hyperaemic pulp, due to their analgesic and antimicrobial properties. It is also not a relatively technique sensitive (or moisture sensitive) procedure, therefore is easy to place in a cavity after simple removal of caries with an excavator or slow hand piece and simple isolation with cotton wool rolls. This may be beneficial in children who suffer from severe dental anxiety and are in acute pain.

I note, however, and agree with the authors, that there should be caution undertaken with the use of Ledermix due to it containing tetracycline as an antibiotic component, which can cause developmental defects in a child especially with the developing dentition. Perhaps most notably is the staining that forms on the dentition as the teeth are being formed. Furthermore, licensing for this product contraindicates its use for children under 12 years of age. As a result, Odontopaste is advocated as the far safer alternative. However, a review of dental retailers has shown that the product has been discontinued in the last year in the UK. Thus it seems that Ledermix is the only available intracanal medicament currently on the market. Are there any other available alternatives that could be used in place of this?