Clinical applications of ferric sulfate in dentistry: A narrative review
Abstract:Ferric sulfate (FS) has been commonly used as a local hemostatic agent for more than three decades in dentistry. Even though the hemostatic mechanism of FS is questioned, it seems that agglutination of blood proteins occurs due to the reaction of blood with ferric and sulfate ions in acidic pH. FS has gained widespread importance as a pulpotomy medicament in contemporary dentistry; nevertheless, it has several applications in different fields of dentistry which was paid little attention. Hence, the purpose of this paper is to review the various applications of FS in dentistry, along with restorative dentistry and endodontics.
Ferric sulfate or FS [Fe2(SO4)3] is a sulfate of trivalent iron. It is yellow in color with a rhombic crystalline salt and is soluble in water at room temperature. It is produced on a large scale by the reaction of sulfuric acid, a hot solution of ferrous sulfate, with an oxidizing agent. It was first introduced in the field of dermatology as Monsel’s solution in 1856.[1] In dentistry, 15%–20% FS is used as an astringent and styptic.[2,3] Hemostatic action of FS is due to the agglutination of blood proteins resulting from the reaction of blood with ferric and sulfate ions in acidic pH.[4] The agglutinated proteins form plugs that occlude the capillary orifices.[5]
FS is available in two chemical forms.
Ferric subsulfate [Fe4(OH)2(SO4)5] (Monsel’s solution)
Monsel’s solution, 20% FS, is used as an effective styptic agent in skin and mucosal biopsies.[1,4,6] However, the ferric and ferrous salts are corrosive and injurious to the soft, as well as hard tissues, causing subsequent staining of the teeth due to its high acidity (pH <1).[4,7] The postoperative complications associated with the soft tissues are delayed reepithelialization and dyspigmentation.[8,9] It also causes reactive and degenerative changes.[1,10] Armstrong et al.[9] observed inflammation, higher incidence of wound infection, and delayed reepithelialization rate in the punch biopsy wounds treated by Monsel’s solution compared to collagen matrix at 4 weeks.
Ferric sulfate [Fe2(SO4)3]
As a 15.5% solution, FS is a coagulative and hemostatic agent which forms ferric ion-protein complex on contact with blood. It seals the damaged vessels mechanically, thus producing hemostasis, and the capillary orifices are occluded by the agglutinated protein complex, which prevents blood clot formation.[1] It causes a local and reversible inflammatory response to the oral soft tissues.[11] The recommended application time is 1–3 min and should be placed directly against the damaged tissue due to its quick action. Solutions of FS above 15% are highly acidic and may cause considerable tissue irritation and postoperative root sensitivity.
PMID 29259368 / Madhuri Bandi, Sreekanth Kumar Mallineni, and Sivakumar Nuvvula