[Direct and indirect effects of medication (including chemotherapy) and irradiation on the pulp]

A direct or indirect effect of the intake of medication on the pulp itself has not yet been described in the literature. The effect of local anesthetics on the pulp, on the other hand, has been documented. Although local anaesthesia has been employed in dentistry for many years, most investigations of its action have only considered the effect on the nerves within the pulp using traditional methods. Recently it has become clear that the nerves and blood vessels of the pulp do not act in isolation but are closely related. In this respect it has been shown that there exists a direct relationship between the length of the flow cessation and the concentration of vasoconstrictor used. Therefore care should be taken when using vasoconstrictors especially where pulpal injury is apt to occur when dental procedures such as full crown preparations are performed immediately following a ligamental injection. The anaesthetic efficacy of intraosseous injection is well documented. The effect, however, on the dental pulpal circulation still remains subject of further investigation. Radiotherapy involving the oral cavity and salivary glands and chemotherapy (in a lesser degree) induce alterations in the oral tissues and the salivary gland functions. Some of these side effects are transient. However there are side effects such as the xerostomia which are very drastic for the dentition resulting in radiation caries and dental hypersensitivity. Tooth anomalies in the developing dentition are also described. Due to the rapid progression of the radiation caries a monitoring of the oral cavity with strict application of preventive measurements and systematic follow-up can reduce the incidence of the complications. Unfortunately most of the patients belonging to this group consult with the complications of their radiotherapy and chemotherapy. In this respect endodontic treatment of the severely decayed teeth is an important part of dental treatment. Moreover, extraction is regularly contraindicated as osteoradionecrosis is then one of the major sequels.