Article

Anatomy of sodium hypochlorite accidents.

Division of Endodontics, University of Colorado, School of Dental Medicine, Aurora, USA.
Compendium of continuing education in dentistry (Jamesburg, N.J.: 1995) 11/2007; 28(10):544-6, 548, 550.
Source: PubMed

ABSTRACT Sodium hypochlorite (NaOCl) in various concentrations is the most widely used endodontic irrigant, but it can be an irritant to vital tissues. There are several reports about the complications of irrigation with NaOCl during root canal therapy. Most of the complications are the result of accidental extrusion of the solution from the apical foramen or accessory canals or perforations into the periapical area. This article is a review and comparison of all reported NaOCl accidents in the literature.

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    ABSTRACT: Objectives Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur. Methods To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavour to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed. Results By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-collapsible venous sinusoids within the cancellous bone is presented. Conclusions Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal débridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system.
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