Arsenic trioxide-induced osteo-necrosis treatment in a child: mini-review and case report.
BACKGROUND
Arsenic oxide compounds were traditionally used as devitalizing agents. Due to its toxicity, leakage of such compounds into the periodontium can cause gingival and osteo-necrosis. Their use is forbidden in Europe and the USA for decades, however, some dentists seem to still use it.


METHODS
We report the case of a 14-year-old girl referred to the paediatric dentistry department of Toulouse University hospital, France, presenting a bone necrosis following the use of an arsenic trioxide product to accelerate pulp necrosis.


METHODS
The treatment included surgical removal of necrosis bone sequestrum, complete pulpectomy and an intermediate restoration of the tooth 27.


RESULTS
After 1 week, the clinical conditions greatly improved. A restoration using a ceramic crown was performed after 2 months, and complete healing was observed after 1 year follow-up.


CONCLUSIONS
Although arsenic trioxide is neither appropriate nor permitted for use in modern dentistry, especially in paediatric dentistry, some rare cases of arsenic-induced osteo-necrosis can still be encountered. A clearer message must be given to all dental practitioners against the use of arsenic trioxide in modern endodontic treatment.
Department of Pediatric Dentistry, Faculté de Chirurgie-dentaire, Toulouse Dental School, University of Toulouse III, 3 chemin des Maraîchers, 31069, Toulouse, France. martymat@hotmail.fr.
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Marty
Department of Pediatric Dentistry, Faculté de Chirurgie-dentaire, Toulouse Dental School, University of Toulouse III, 3 chemin des Maraîchers, 31069, Toulouse, France.
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Noirrit-Esclassan
Department of Endodontics, Faculté de Chirurgie-dentaire, Toulouse Dental School, University of Toulouse III, 3 chemin des Maraîchers, 31069, Toulouse, France.
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Diemer
D000293:Adolescent; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000009:adverse effects*; D003764:Dental Materials / Q000009:adverse effects; D003787:Dental Pulp Devitalization / Q000009:adverse effects; D003790:Dental Pulp Necrosis / Q000188:drug therapy*; D005260:Female; D005602:France; D005882:Gingival Diseases / Q000139:chemically induced; D006801:Humans; D008336:Mandibular Diseases / Q000139:chemically induced; D009336:Necrosis / Q000139:chemically induced; D010020:Osteonecrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010087:Oxides / Q000009:adverse effects*; D011670:Pulpectomy
D001152:Arsenicals; D003764:Dental Materials; D010087:Oxides; D000077237:Arsenic Trioxide
Arsenic trioxide; Endodontic; Osteo-necrosis