In my practice, I have treated several patients from Russia who said they had received this therapy. I have found that the canals in these patients’ treated teeth have been obturated by one of two materials: a soft gutta-percha–like cement or a hard white cement. Complete débridement of the canals often had not been performed, as evidenced by the high incidence of incompletely filled canals and persistent or recurrent periapical pathology.

A common presentation of teeth that received endodontic therapy in Russia may be described best as pink teeth. In these cases, I have found the dentin to be stained red or orange and the canals to be obturated with either the soft gutta-percha–like cement or the hard white cement. My patients have suggested that the pink color of their teeth was the result of the use of resorcinol in the filling material used in the teeth. I was able to confirm that resorcinol and formalin are used in endodontic therapy in Russia during a recent visit to a dental clinic in Sarov, Russia (I. Akkuratova and L. Turovets, oral communication, April 2000). These Russian stomatologists told me that the red color is evident in teeth in which resorcinol has been used overzealously and that the method no longer is used in their clinic.

I have discovered pink primary and permanent teeth during routine examinations of Russian patients. A 43-year-old Russian man with two pink teeth came to my practice (Figure). He reported that these teeth had been treated with arsenic and resorcinol in the methods described previously.

View larger version (96K): [in this window] [in a new window]   Figure. Pink premolar resulting from Russian endodontic therapy.

A proper diagnosis must be made before treatment is initiated because of the differences in proper treatment for these diverse pink teeth. For example, although the color of dentin in teeth treated with resorcinol may be disturbing to Western dentists, I believe that it is imprudent to excavate red dentin without first applying judicious amounts of caries indicator dye. Also, primary teeth that are pink as the result of being treated with resorcinol are just as effective at space maintenance as are vital teeth, and they should not be routinely extracted in advance of normal exfoliation. It should be noted that although radiographs are essential in making an accurate diagnosis, dental radiography is limited in Russia, and Russian patients may be reluctant to submit to routine diagnostic radiographs.

In permanent teeth, endodontic retreatment usually is necessary before definitive restoration takes place; however, in cases in which these teeth have canals obstructed by hard white cement, conventional retreatment has been difficult or impossible to perform. In these cases, apicoectomy with retrofill usually is advisable.

Though apparently rare, postoperative sequelae from the use of arsenic trioxide can be dramatic and dangerous and include focal osteolysis, fibrosis and paresthesia.² It is important to view similar symptoms in patients from Eastern Europe or Asia as possibly arising from previous pulp treatment with arsenic trioxide. The peripheral effects of the use of resorcinol appear to be limited to the color change.

CONCLUSION
As a clinical curiosity, these pink teeth are impressive to observe. In the interest of proper treatment, however, it is important to diagnose pink teeth correctly and to be aware of the materials and methods that were used in their original treatment.

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