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


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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    • "As a result, in vivo (Lamers et al. 1980, Watts & Paterson 1993) and ex vivo studies (Hauser et al. 2007, George & Walsh 2008, Desai & Himel 2009, Mitchell et al. 2011) have tried to elucidate the parameters influencing irrigant extrusion. Literature reviews on the subject have also been published (H€ ulsmann & Hahn 2000, Mehdipour et al. 2007, Spencer et al. 2007, H€ ulsmann et al. 2009). However, despite the large number of case reports and experimental studies and the clinical importance of the symptoms following irrigant extrusion, there is a surprising absence of critical appraisal of the published data and synthesis of the available evidence, which are currently substituted by speculation to a large extent. "
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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.
    Full-text · Article · Nov 2012 · International Endodontic Journal
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    • "Sodium hypochlorite (NaOCl) is a commonly used irrigant in root canal treatment offering disinfection and debris removal because of its effective ability to dissolve organic soft tissue because of its powerful oxidation ability (Mentz 1982, Ayhan et al. 1999, Mehdipour et al. 2007). The disadvantage of NaOCl is that it can cause acute inflammation followed doi:10.1111/j.1365-2591.2011.02009.x "
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    ABSTRACT: To show the radiographic manifestation of sodium hypochlorite after accidental injection past the apical foramen and into the soft tissues. A female patient was seen for an emergency visit after suffering a sodium hypochlorite accident at her general dentist's office. The patient was seen within 1 h of the accident and was in pain associated with facial swelling. Radiographs, including a Cone Beam Computed Tomography (CBCT), and photographs were taken. Endodontic emergency treatment was initiated. The patient was reassured and given pain medication and antibiotics. Follow-up visits were scheduled over 6 days when the swelling had resolved. • Importance of multiple radiographic images during preoperative endodontic evaluation when undertaking endodontic retreatment. • Knowledge of apical anatomy as related to surrounding structures. • Effect of sodium hypochlorite when injected in the soft tissues.
    Full-text · Article · Jan 2012 · International Endodontic Journal
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    ABSTRACT: 09E01561 Irigasi merupakan bagian penting dari proses pembersihan pada perawatan saluran akar. Ada berbagai jenis larutan irigasi yang terbagi dalam tiga golongan besar yaitu golongan halogen, golongan detergen dan golongan chelating agent. Suatu bahan irigasi yang baik harus mampu melarutkan jaringan organik dan anorganik, melancarkan alat endodontik, bersifat antimikroba serta mempunyai efek toksisitas yang rendah. Sodium hypochlorite menjadi pilihan dalam mengirigasi saluran akar karena mekanisme kerja antimikroba yang efektif dalam mengurangi jumlah bakteri dalam saluran akar. Mekanisme kerja sodium hypochlorite terdiri dari 3 reaksi, yaitu reaksi saponifikasi, reaksi netralisasi dan reaksi kloraminisasi. Namun, sodium hypochlorite juga mempunyai efek toksik pada jaringan vital apabila digunakan dalam konsentrasi setinggi 5.25%. Oleh hal demikian, konsentrasi sodium hypochlorite 1% adalah lebih biokompatibel pada jaringan vital tubuh. Efek toksik sodium hypochlorite sangat dipengaruhi oleh konsentrasi larutan, pH, serta lama waktu larutan sodium hypochlorite bereaksi dengan jaringan vital. Penyemprotan larutan sodium hypochlorite kearah jaringan periapikal dapat menyebabkan rasa sakit,ulserasi,hemolisis, odema serta pembengkakan.Oleh karena itu, perawatan yang baik dan adekuat harus diberikan untuk mencegah terjadi infeksi sekunder. Pencegahan toksisitas dapat dilakukan dengan preparasi saluran akar yang adekuat, penentuan panjang kerja yang baik serta menguasai teknik irigasi yang benar. Sitti Chadidjah Az, drg
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