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Interview: “Bioactive endodontics is the future”

Dr. James Bahcall and colleagues are exploring the possibilities of cryotherapy in endodontic dentistry. (Photograph: Dr. James Bahcall)
Monique Mehler, Dental Tribune International

Monique Mehler, Dental Tribune International

Mon. 8. July 2019

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In the medical field, cryotherapy is used in an effort to relieve pain and swelling after soft-tissue management or surgery. Currently, researchers in the U.S. are exploring the possibilities and limitations of vital pulp cryotherapy in clinical trials. Dr. James Bahcall, who plays an important role in these investigations, is a clinical professor at the University of Illinois at Chicago. He spoke to Dental Tribune International about the studies.

Dr. Bahcall, in collaboration with other researchers, you have published an article titled “Introduction to vital pulp cryotherapy” in which the use of cold therapy in endodontics is explored. What is the history behind the use of  cryotherapy in vital pulp therapy?
There has been a paradigm shift in vital pulp therapy over the last three to five years. We have gained a better understanding of pulp biology from caries involvement, and there have been new developments in bioceramic materials. We have also come to view vital pulp therapy as a permanent rather than temporary dental treatment. All of this allowed us to develop vital pulp cryotherapy. Although we did not invent cryotherapy, we were the first to bring it into endodontics for vital pulp treatment. Medicine has demonstrated since the early 1960s that cryotherapy can reduce nerve pain response, inflammation and hemorrhaging, and can help reduce a patient’s need for postoperative pain medications.

Vital pulp cryotherapy is performed when a carious lesion is removed from a tooth and there is direct or indirect exposure of the dental pulp. The cryotherapy portion of treatment involves placing sterile ice on the exposed pulp. The application of ice lowers the temperature of the tooth’s blood and nerve supply, and this has been shown clinically to reduce inflammation and post-treatment tooth pain. It is important to note that, after performing the cryotherapy procedure, 17% EDTA irrigation is applied, a bioceramic material is then placed over the directly or indirectly exposed pulp, and the tooth is restored with a permanent restorative material, such as composite or amalgam.

How is this different from classic root canal therapy?
Vital pulp cryotherapy involves treating a carious tooth while maintaining the tooth’s pulpal tissue as opposed to root canal therapy that involves removal of the entire dental pulp and replacing it with gutta-percha and sealer.

What are the benefits of vital pulp cryotherapy, and what are its limitations?
The benefits of vital pulp cryotherapy are its ability to eliminate pulpal inflammation and a patient’s tooth pain without the complete removal of the dental pulp. By maintaining the dental pulp, we are able to maintain the tooth’s strength by not having to remove root dentin, the pulp–dentin complex and the pulp’s immune defense mechanisms. Another benefit of vital pulp cryotherapy is the treatment time for the patient. Once the patient is properly anesthetized and the caries is removed, the actual time to complete the vital pulp cryotherapy portion is 10–15 minutes. In comparison, root canal therapy can take 1–2 hours. Vital pulp therapy procedures are completed in one patient treatment visit.

The limitation of vital pulp cryotherapy is that this procedure can only be performed on vital teeth that can be permanently restored with composite or amalgam immediately after the procedure. It cannot be performed with necrotic or partially necrotic pulps. A clinician cannot prepare a vital pulp cryotherapy treated tooth for a crown. The reason for this is that, once the vital pulp cryotherapy is completed, you do not want to do any further dental treatment to this tooth because you risk the possibility of restimulating the pulpal inflammation.

In your article, you conclude that further clinical studies are needed in order to establish the long-term prognosis of a pulp after vital pulp cryotherapy. What are your expectations?
As with any new dental procedure, clinical cases and studies need to be published in peer-reviewed dental literature. Vital pulp cryotherapy is no different. We have published case reports and have been conducting clinical research on vital pulp cryotherapy. Our study has found that patients have less postoperative pain immediately after treatment and maintain normal pulp vitality at six months and at one year after treatment. This is as far as our clinical study has patient recalls at this point. Our expectations are, firstly, to demonstrate that this is a valid procedure for vital pulp treatment beyond one year. Secondly, we hope to encourage our dental colleagues to publish vital pulp cryotherapy case reports and clinical research in the dental literature.

How do you think vital pulp cryotherapy will advance endodontics?
We feel that vital pulp cryotherapy will help to broaden the type of pulpal treatment that we can provide to our patients. It also will be an important treatment component in bioactive endodontic therapy. Bioactive endodontics is the future. By definition, “bioactive” means having a biological effect. Bioactive endodontics in conventional endodontic treatment includes vital pulp cryotherapy and regenerative endodontics. It involves the use of bioactive materials and the patient’s own blood to help heal, as in the case of vital pulp cryotherapy, and to replace the gutta-percha and sealer in classic root canal therapy.

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Study links adolescent tooth loss to bullying

A recent study has shown that adolescent tooth loss can make bullying more likely. (Image: InsideCreativeHouse/Adobe Stock)

MELBOURNE, Australia: Tooth loss can have a profound impact on social interactions and self-esteem. While poor oral health is known to be associated with various forms of social disadvantage, the link between tooth loss and bullying has received little attention. A recent study by researchers from the University of Melbourne has found that adolescents who have lost teeth owing to dental caries or trauma are more likely to experience bullying, underscoring the importance of caries prevention and trauma management.

Data published by the Australian government indicates that bullying is common in the country: 70% of children aged 12–13 have experienced at least one incident. Additionally, as many as 36% of children in this age group said that they experienced bullying monthly or even weekly. Victimisation can have significant mental health consequences, including depression and anxiety, which are associated with suicidal behaviours and substance abuse. It is also linked to physical outcomes such as obesity and inflammation.

Senior author Dr Ankur Singh, chair of lifespan oral health at Melbourne Dental School, said in a press release: “Tooth loss isn’t only a dental issue; it’s a social one too. For teenagers, it can have significant psychological impacts at a crucial time in their development.”

The study analysed data from the Longitudinal Study of Australian Children, looking at 4,476 children from ages 8–9 through to 14–15 years. The researchers examined the participants’ incidence of tooth extractions due to caries or trauma and assessed bullying victimisation based on parent-reported cases of school bullying.

The findings showed that approximately 10% of children in the study had lost teeth through caries or injury and that children from lower socio-economic backgrounds, as well as rural or remote areas, were more likely to have experienced tooth loss. It also found that adolescents who had lost teeth faced 42% higher odds of being bullied.

In light of the findings, Dr Singh emphasised that poor oral health affects nutrition, sleep, self-confidence and overall well-being and is associated with conditions such as heart disease and high blood pressure. He said: “The government needs to invest in prevention programmes tackling oral health and improve equitable access to dental care, especially in rural and remote areas and in low-income communities.”

Lead author Yuxi Li, a PhD candidate at the University of Melbourne, noted: “Anyone who has been bullied at school can testify to what an awful experience it can be.” She continued: “As well [as] poor psychological outcomes, bullying can also have adverse physical outcomes such as overweight and obesity.”

The findings highlight the importance of prioritising preventive dental care and early intervention to lessen the social consequences of poor oral health. The researchers suggested that policymakers should integrate oral health initiatives into school-based anti-bullying programmes to help reduce the cascading effects of bullying on adolescents’ mental health and social well-being.

“We hope that this study will raise awareness about the link between oral health, bullying and young people’s overall well-being,” Li concluded.

The study, titled “Does tooth loss lead to school bullying? Evidence from the Longitudinal Study of Australian Children”, was published online on 17 August 2025 in JDR Clinical and Translational Research, ahead of inclusion in an issue.

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