The Drug Administration of Vietnam (DAV), under the Ministry of Health, announced that its functional department will review drug registration licensing data. This review aims to determine if arsenic-containing dental pulp devitalizers were ever licensed and, if so, whether those licenses remain valid. Meanwhile, the Department of Medical Infrastructure and Equipment, after its review, stated it found "no dental medical equipment using arsenic." However, this department currently lacks official information regarding whether any arsenic-containing medical supplies or materials used in dentistry have been licensed.

This review follows a recent police crackdown on an illegal network involved in the handmade production and sale of arsenic trioxide (white arsenic) to numerous dental clinics. Medical experts express concern that arsenic-containing pulp devitalizers in dentistry could pose serious health risks if their use is not strictly controlled.

A doctor examines a patient's teeth. Photo: Nguyen Thu.

Master of Science, Doctor Duong Minh Tung, a specialist in orthognathic surgery and implantology at Platinum Dental, explained that arsenic was once used in "pulp devitalizers" during the early days of dentistry. At that time, endodontic procedures were rudimentary, and pain control was limited. The purpose of these devitalizers was to alleviate pain by gradually necrotizing the pulp tissue. With the pulp losing sensation, dentists found it "easier" to remove the pulp during subsequent appointments after opening the previous filling. This spared patients the intense pain of direct manipulation on live pulp, similar to cases where a tooth's pulp had died long ago.

These early pulp devitalizers contained arsenic trioxide (As₂O₃), a cytotoxic poison. When placed in the pulp chamber, arsenic gradually damaged and necrotized the pulp tissue. It could also constrict blood vessels, reduce blood flow, leading to the pulp losing nourishment and dying. At a cellular level, it disrupted energy metabolism, breaking the cell's energy production chain, causing cells to cease function and die. As pulp tissue necrotized, the nerve receptors within the pulp were also destroyed, resulting in reduced or lost pain sensation.

This mechanism, however, presented a significant danger: arsenic is non-selective. It not only affected pulp tissue but could also be toxic to all surrounding living tissues. If a tooth had cracks, a temporary filling was not sealed properly, the medication leaked, or a patient left the medication in for too long, the toxin could spread to the periapical area and oral tissues. This led to severe complications, including mucosal ulcers, gum necrosis, bone necrosis, cellulitis, prolonged pain, and tooth mobility. In cases of prolonged exposure or tissue absorption, arsenic could even enter the bloodstream, causing systemic poisoning. Therefore, despite its ability to devitalize pulp, this method carried high risks and is no longer suitable for current standard endodontic treatment.

"Today, with advancements in anesthesia, sterilization, and endodontic techniques, this method is no longer safe and has been eliminated from standard treatment", Doctor Tung said.

In clinical practice, however, cases involving arsenic use can still occur, typically from older treatments or in substandard clinics. Doctors often encounter situations where patients had "medication placed then re-scheduled," subsequently experiencing complications like persistent pain, irritated or ulcerated gums, or periapical tissue damage due to medication leakage. When facing such cases, dentists must perform thorough examinations and take X-rays to assess the extent of the damage before determining an appropriate treatment plan.

The continued use of "pulp devitalizers" in some places often stems from outdated habits or substandard practices, aiming to avoid immediate "live pulp manipulation." However, compared to modern endodontics, arsenic is inferior in nearly every aspect. With effective anesthesia, patients become numb very quickly (usually within a few minutes), allowing the dentist to perform treatment in a single session, followed by normal patient recovery. In contrast, using arsenic prevents immediate treatment, often requiring a waiting period of one to three days, during which patients may still experience discomfort and sometimes need medication.

More importantly, modern anesthesia does not destroy tissue. If complications arise from arsenic use, the consequences can be irreversible due to its toxicity and damage to surrounding tissues. These represent two fundamentally different approaches: one is controlled, precise, and safe, while the other involves a toxic substance, waiting, and high risk.

Experts also noted that in light of these consequences, the global and Vietnamese medical sectors have gradually restricted, and are moving towards not recommending, the use of arsenic-containing preparations in dentistry. In practice, most hospitals and dental facilities now use modern anesthesia and treatment methods, completely replacing arsenic. Legally, all products used in medical treatment must have a clear origin and be licensed for circulation by the Ministry of Health. Individuals who independently purchase industrial chemicals, mix them, and use them in dentistry are committing an illegal act, violating legal regulations and directly threatening public health.

Doctor Tung advises patients seeking dental care to understand their diagnosis and the proposed treatment plan, including: the specific steps involved, the estimated number of appointments, and the approximate total duration. Before each appointment, dentists should also explain "what will be done today" to ensure patients feel reassured and informed.

Le Nga