Q&A: Control
Astringedent | Astringedent X | ViscoStat | ViscoStat Clear
Astringedent
- contraindications when used with Astringedent X
- iodine content
- percent_acidity
- pH
- vs . Astringedent X
- vs . ViscoStat
Astringedent X
- contraindications when used with Astringedent
- percent acidity
- pH
- vital pulpotomies , use in
- vs . Astringedent and ViscoStat
ViscoStat
- acidic effect
- effect on dentin
- effect on smear layer
- effects on bonding
- epinephrine
- epinephrine anesthetic
- impression material, polyether
- impression material, hydrocolloid
- periodontal surgeries
- periodontitis recession
- pH
- pulpotomies
- retraction effect
- staining
- sulfa allergies
- sulfur content
- vs Astringedent
- vs Astringedent X
- wintermint flavoring
ViscoStat Clear
- aluminum chloride vs. aluminum sulfate
- Dento-Infusor tip, use with
- epinephrine , reaction to
- ferric sulfate content
- mechanism of function
Technical Q&A
Are there any contraindications for using ASTRINGEDENT and then ASTRINGEDENT X on top of it if the ASTRINGEDENT didn't work well enough?
No.
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Does ASTRINGEDENT contain iodine?
No.
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What is the pH of ASTRINGEDENT?
The pH of Astringedent is 1.
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Why is the pH of ASTRINGEDENT X the same as the pH of regular ASTRINGEDENT even though the percent acidity and content of ferric sulfate is higher?
The pH of Astringedent is 1.3~1.6 and the pH of Astringedent X is 1.2~1.4. Percent acidity or acid number is a relative number for comparing levels of acidity, e.g. a chemical with a percent acidity of 20 would require two times as much known base to neutralize it as would a chemical with a percent acidity of 10. There is a correlation of this number to pH, however in most cases, it is an indirect correlation. For example, the pH of 40% phosphoric acid is close to zero and its percent acidity is close to 90. The pH of 20% phosphoric acid is still approximately zero, yet its percent acidity would be 1/2 that of the 40%. The acid number is meaningful from a physiological standpoint, providing clinicians with a relative number that allows them to get a feel for how quickly a low pH chemical should be buffered and neutralized by body fluids, etc. Acid and base effects on tissues are related not only to concentrations but also the length of time they are active on tissues. Therefore, it would take more time to neutralize Astringedent X than Astringedent .
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Can ASTRINGEDENT X be used for vital pulpotomies?
Studies have not been performed using Astringedent X (ferric subsulfate) for vital pulpotomies .
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When would ASTRINGEDENT X be recommended instead of ASTRINGEDENT OR VISCOSTAT?
Astringedent and Viscostat would be used on 85% of patients. Astringedent X would only be used for the remaining 15% of patients, namely patients who are on Coumadin (which is a blood thinner), aspirin therapy, or who are hemophiliacs, etc. If the regular Astringedent does not stop the bleeding then Astringedent X can be used right over the top. We don't recommend Astringedent X for all cases because it is more acidic.
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How do ASTRINGEDENT and VISCOSTAT differ in application?
Astringedent and Viscostat could actually be used interchangeably for 95% of the uses. Some differences between them include the following:
Astringedent is the original, classic hemostatic . One place Astringedent is particularly useful is for periapical hemostais through a NaviTip into the canal. (Take care not to express it past the apex.) The viscous formulas aren't logical to use for that procedure. The viscous formula facilitates greater control than Astringedent and don't remove smear plugs from dentin surfaces – even after several minutes of exposure to the dentin. Astringedent will etch out smear plugs after a few minutes of exposure on the dentin as do most all mineral astringent hemostatics , be they aluminum chloride, aluminum sulfate etc.
Ferric sulfate solutions, namely ViscoStat and Astringedent , have been shown to be as effective as formocresol for vital pulpotomies on primary teeth (note the catalog for steps and lit references). There have been many studies done on this usage over the last 15 years.
Additionally, studies have been done using Astringedent and ViscoStat against bone for retro fills.
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What is the abrasive pumice in CONSEPSIS SCRUB?
Consepsis Scrub contains a silicate abrasive.
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What is the purpose of PREPQUICK?
PrepQuick is a chemistry designed to increase ease, quality and predictability with impression making when using primarily hydrophobic impression materials such as silicone. Smear layer is selectively removed and wetting enhancement occurs relative to silicone, etc. on hydrophilic dentin.
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What is the setting time for ULTRATEMP?
UltraTemp has a working time of approximately 2 to 2.5 minutes and sets firm in approximately 4.5 to 5 minutes. UltraTemp is water soluble until set
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Is it correct to say that the buffering effect of VISCOSTAT makes it such that the acidic effect and hemostatic effect occur mostly at the point the substance is rubbed with the Dento-Infusor, thus limiting the action of the product to the sulcus, not the tooth?
This is correct. Studies show that all hemostatics with a low pH can affect the smear layer enough to open dentin tubules and potentially cause pulpal sensitivity. However, ViscoStat contains binders and coating agents that minimize the acidic effect making it less aggressive than other hemostatic agents. An article published in the May 1995 issue of Practical Periodontics and Aesthetic Dentistry by Dr. Dan Fischer and Dr. John Bailey addressed this subject. The article presented a scanning electron microscopic (SEM) image of dentin after a four-minute exposure to ViscoStat hemostatic solution followed by rinsing. A second SEM of ViscoStat solution applied to prepared dentin surface showed the smear layer intact after an eight-minute application. The smear plugs maintain tubule closure even after these extreme exposure times. This indicates that ViscoStat is kind to hard tissues.
This formulation further reduces negative effects on dentin with the correct use of the Dento-Infusor tip. The agitation and pressurized delivery with the applicator causes increased activity of the solution's chemistry at the location of mechanical activation, namely rubbing for predictable hemostasis, again protecting the hard tissues.
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Does ferric sulfate negatively affect the bonding process?
A thorough air/water rinse followed by the etch step of a bonding system will remove the residual ferric sulfate that could interfere with bonding. With respect to self-etching bonding agents, Ultradent advises doctors “not to use Astringedent, ViscoStat or other Ultradent hemostatics prior to application of [a] self-etching primer . . . unless at least a scour cleaning step is used immediately prior to the primer application. This will not be taught as mandatory for conventional systems providing a stand-alone etch/conditioning and wash step prior to resin application.” (Fischer, Dan E. Effects of Chemical Preconditions on Dentin and Bonding Strength of Liner Bond II to Dentin.)
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If ViscoStat residue remains on the tooth after rinsing, will there be any adverse effects on bonding?
Yes, leaving any residue on the tooth will interfere with the bond strengths. We recommend using Consepsis Scrub if using a self-etching bonding system. If using a conventional bonding system, it is not necessary; the stand-alone etch will effectively remove the ViscoStat residue. A good air/water spray is always recommended to facilitate cleaning.
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Is there any problem when a polyether material is used following hemostasis with Astringedent or ViscoStat?
Polyether materials are negatively affected by residual ferric sulfate on the preparation. Good air/water washing totally negates effect. As a precaution, Consepsis Scrub or pumice and an ICB Brush may be used to scour it completely. This shouldn't start any further bleeding because active hemostasis is already achieved. If bleeding is initiated, repeat the tissue management steps and re-scour prior to the impression.
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Does the use of Astringedent interfere with the release of hydrocolloid?
We recommend the use of a silicon emulsion release agent when using with reversible hydrocolloid, as the infusion technique of tissue management is so profound in stopping the bleeding and drying the tissues that said release agent is recommended with this hydrophilic impression material.
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What is the pH of VISCOSTAT?
The pH of ViscoStat is ~1.
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Can ViscoStat be used in periodontal surgeries?
Viscostat can be used with perio surgeries but only when and where it can be applied to surface capillary-type bleeding. This means it works nicely for such procedures as gingivectomies and to donor sites of free gingival grafts, but it should not be used under flaps where the artificial coagulum would be entrapped.
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Can ASTRINGEDENT/VISCOSTAT affect the recession of gums in the anterior segment because of reduced blood supply?
If a periodontal condition is present, the application of any astringent material could cause gingival recession related to its chemistry. Simply leaving a displacement cord in the sulcus for an extended period of time can also cause the same type of occurrence.
The physical effect of Astringedent or ViscoStat is to create a coagulum plug that will seal off any open vessel. When applied as per the instructions, it is not present long enough to have an irreversible vasoconstrictor effect that would reduce circulation to the tissues.
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How long will the retraction effect with ASTRINGEDENT/VISCOSTAT carry on after the cord is pulled out?
One of the primary effects of astringent displacement chemicals is their ability to affect the collagen memory of the gingival tissues. Ramadan published in the Egyptian Dental Journal that the astringent effect can provide retraction for up to 23 minutes in dogs. The critical issue here is the application time necessary for the chemical to produce this level of effect. ViscoStat requires only 1 to 3 minutes of application in a blood-free sulcus to provide adequate space for impression-making procedures. An evaluation of closure times has not been performed on ferric sulfate materials. Clinical experience has established that the 1 to 3 minute application time will provide several minutes of viable retraction for the majority of patients.
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What causes ASTRINGEDENT, VISCOSTAT, etc. to stain the soft tissues?
The "staining" that the dentists are seeing may be the coagulum plugs in the cut capillaries. Like any cut tissue injury, it will take time for the tissue to heal and the coagulum to dissipate, at which time the tissues should return to their original state. The so-called staining is the ferric ion combined with the coagulum plugging the once-bleeding blood vessels. Because of this, in thin tissue or areas with an excessive number of open vessels, the coagulum plugs may be more visible and discoloration of the effected tissues would be noticeable. This will clear in the normal 24 to 48 hours.
It is important for the dentist to rinse really well with a firm air/water spray after placing the Astringedent and cord as well as when the cord is removed. This will wash any residual Astringedent off the tissues.
It is also important for the assistant to drizzle water over the infusion sites to help wash the excess coagulum away while achieving hemostasis.
Note: If Astringedent is used with epinephrine there is a reaction that can cause the gingival tissue to temporarily turn a dark blue or black color.
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Can ViscoStat and Astringedent be used with anesthetic solutions containing epinephrine?
Yes.
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Are there contra indications for using ferric sulfate on a patient with allergies to sulfa?
No. Sulfate doesn't relate to sulfur any more than chloride (e.g. sodium chloride) would equate to chlorine.
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Is the flavoring in Wintermint VISCOSTAT natural or artificial?
Artificial.
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What is the difference between aluminum chloride and aluminum sulfate?
Both aluminum chloride and aluminum sulfate can be used as hemostatics, just like ferric sulfate and ferric chloride are used. The main difference is that the chlorides tend to be more caustic and corrosive than the sulfates and therefore, are not as kind to metals or tissues. However, both work about the same clinically.
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Why use the Dento-Infusor tip if VISCOSTAT CLEAR does not plug capillaries?
Although this product functions differently than original ViscoStat, the Dento-Infusor tip is still a preferred method of direct delivery. The brush fibers are kind to tissues, adjustable for ideal customization and allow you to spread the material efficiently.
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Is there a reaction between VISCOSTAT CLEAR and epinephrine like there is with original ViscoStat?
No, there is no reaction.
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Does VISCOSTAT CLEAR contain ferric sulfate?
No, ViscoStat Clear does not contain ferric sulfate. Therefore, it will not coagulate blood immediately like the original ViscoStat will.
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How does the aluminum chloride in VISCOSTAT CLEAR function as a hemostatic solution?
Questions have been posed as to the nature of how aluminum chloride functions as a hemostatic solution. Some have proposed that aluminum chloride functions as a coagulative hemostatic similar to ferric sulfate, while others have favored the vaso-constriction concept. In reality, this product does create vaso constriction, but not via the customary mechanism of vascular smooth muscle constriction like what occurs with epinephrine. Aluminum chloride causes the collagen fibers in the tissues around the capillaries (and everywhere else it comes into contact with) to swell. Albeit this occurs to a greater degree with aluminum chloride than with other mineral astringents, it occurs with them all to varying levels. The expansion of the collagen around the capillaries induces pressure on them, which causes them to constrict. I discovered this via extensive histological study in the early eighties. Relative to coagulative capability, test for yourself. Take a few drops of fresh blood. Place one or two drops of ferric sulfate in one puddle of blood and aluminum chloride in the other puddle of blood. Stir the two and witness the difference. Ferric sulfate with blood will instantly initiate formation of coagulum. Aluminum chloride will not.
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Updated 01/03/2006
