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: Abstract Objective: The aim of this study was to investigate the effectiveness of photoactivated disinfection (PAD) in killing Enterococcus faecalis (EF) in planktonic solution and in an infected tooth model. Methods: One hundred and thirty-two glass tubes of EF samples with concentration of 10(14) colony forming units (CFU)/mL and photosensitizer were prepared. Sixteen groups were set up and subjected to diode laser, and then received a radiation energy dose ranging from 0.5 to 5.5 J. The bactericidal effect was measured by the mean CFU of viable EF after irradiation. Sixty single-rooted teeth were selected and contaminated with EF, and then given PAD therapy; 5.25% NaOCl irrigation and saline solution were used to disinfect the root canals. Microbial samples were taken before and after disinfection, and after 72 h recovery, and then the CFU were counted. Results: The bactericidal effect increased linearly with the irradiation energy dose in planktonic solution. For the same irradiation energy dose, the bactericidal effect was greater in group receiving 100 mW than in that receiving 50 mW and exposed to doubled irradiation time (p<0.05). No bacterium was detected after irrigation in the NaOCl group in the root canal model, but the recovery of bacteria after 72 h was detected in 11 samples. Bacteria were detected in all the other groups, and PAD was significantly more effective than saline solution in reducing the number of bacterial cells within the root canals (p<0.05). Conclusions: PAD was shown to have bactericidal effect on EF, and the bactericidal effect increased linearly with the irradiation energy dose and was superior using higher output power. PAD could decrease EF in root canals effectively, but was no more effective than 5.25% NaOCl, and PAD is more effective in planktonic solution than in root canals.
    Photomedicine and laser surgery 10/2012; · 1.76 Impact Factor
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    ABSTRACT: The aim of the present study was to conduct a systematic review and critical analysis of published data on irrigant extrusion to identify factors causing, affecting or predisposing to irrigant extrusion during root canal irrigation of human mature permanent teeth. An electronic search was conducted in Cochrane Library, LILACS, PubMed, SciELO, Scopus and Web of Knowledge using a combination of the terms 'irrigant', 'rinse', 'extrusion', 'injection', 'complication', 'accident', 'iatrogenic', 'root canal', 'tooth' and 'endodontic'. Additional studies were identified by hand-searching of six endodontic journals and the relevant chapters of four endodontic textbooks, resulting in a total of 460 titles. No language restriction was imposed. After applying screening and strict eligibility criteria by two independent reviewers, 40 case reports and 10 ex vivo studies were included in the review. A lack of clinical studies focusing on irrigant extrusion during root canal irrigation was evident. The reviewed case reports focused mainly on the clinical manifestations and management of the accidents and did not provide adequate details on the possible factors that may influence irrigant extrusion. The data from the included ex vivo studies were inconclusive due to major methodological limitations, such as not simulating the presence of periapical tissues and not assessing the validity of irrigant detection methods. The extensive variability in the protocols employed hindered quantitative synthesis. The choice of factors investigated in ex vivo studies seems not to have been driven by the available clinical evidence. These issues need to be addressed in future studies.
    International Endodontic Journal 11/2012; · 2.05 Impact Factor
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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.
    Journal of dentistry 08/2013; · 3.20 Impact Factor


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