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BDS4 Endodontics > 5. Sodium Hypochlorite Extrusion > Flashcards

5. Sodium Hypochlorite Extrusion Flashcards

1
Q

What are common symptoms as a result of sodium hypochlorite extrusion?

A

pain

swelling

ecchymosis

haemorrhage

neurological complications

airway obstruction

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2
Q

Where does ecchymosis manifest in sodium hypochlorite extrusion?

A

along course of superficial venous vasculature

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3
Q

What are rates of sodium hypochlorite extrusion?

A

Rate - less than 50 cases in almost 40 years and we do millions of RCTs every year

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4
Q

What are risk factors of sodium hypochlorite extrusion?

A

Excessive pressure during irrigation - risks pushing solution into peri-radicular tissues

Needle locked within the canal - can risk pushing solution forward

loss of control of working length

larger apical diameters - root resorption, immature teeth

Anatomical factors

Higher NaOCl concentration

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5
Q

Why can pressure cause hypochlorite extrusion?

A

If pressure is great enough to cause hypochlorite to cross the vascular wall and enter the blood supply then we end up with hypochlorite being passed through the vasculature which leads to ecchymosis

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6
Q

What facilitates passage of hypochlorite through the vasculature?

A

Facial venous drainage anatomy - it occurs when the pressure generated by the positive pressure irrigation delivery system at the periapex exceed the venous pressure in sueprifical veins of neck

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7
Q

When will hypochlorite enter venous vasculature?

A

If the pressure generated by the needle and syringe system at the peri apex is greater than the venous pressure in surperifical neck veins

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8
Q

What is the flow rate of superficial veins of neck?

A

1m/15 seconds

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9
Q

How do we avoid forcing hypochlorite into venous vasculature?

A

We want to ensure we never lock the needle and dont exceed flow rate of 1ml/15 seconds

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10
Q

Why can we risk hypochlorite accident if we lose control fo working length?

A

if we aren’t aware of working length and needle length we can penetrate the apical aspect of the tooth - we must ensure if we aren’t aware of needle length we avoid coming into close proximity of apical anatomy

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11
Q

How do we ensure we dont loose control of WL?

A

we need to make sure we establish a WL before starting and make sure the needle is a few mm short of WL

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12
Q

How do we control how far needle goes into canal?

A

use rubber stop or bend needle short of EWL (>2mm from WL)

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13
Q

What teeth must we take care on when doing RCT?

A

teeth with root resorption

immature teeth

pre existing perfs

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14
Q

What happens if root tip lies within maxillary antrum?

A

must proceed with caution!!! - use much less pressure to prevent extrsion of NaOCl

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15
Q

How do we manage a sodium hypochlorite accident?

A
  1. stop all tx
  2. keep calm and dont alarm pt - get consultant
  3. let pt know what has happened and reassure them that we will provide immediate management
  4. if pain is present then we can consider LA block
  5. if profuse bleeding through RC then we allow this to occur until haemostasis occurs
  6. Place steroid containing intracranial medicament in canal with no pressure
  7. no obturation occurs - we seal coronal access cavity
  8. pain relief reduction of swelling nd preventing infection is most important
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16
Q

What advice do we give to pts who have had hypochlorite accident?

A

Analgesic advice - ibuprofen or paracetamol

cold compress for first few days

warm compresses for soft tissue swelling and eliminating haemotoma

review after 24hrs

antibiotics

if severe refer

17
Q

What must we do before using NaOCl?

A

Carry out careful pre op radiographic assessment to asses for open canals, perforations etc

assess pre endo restorative state of tooth - if we need to do pre endo build up we can compromise isolation

18
Q

What must we provide pt with when using NaOCl?

A

Bib to protect clothing - may need more than one

Protective eyewear

19
Q

What must we use during endo tx as gold standard?

A

Rummer dam to isolate tooth and ensure sealed well with oraseal

20
Q

What do we use to seal dam?

A

Oraseal - we mould this to tooth contour with damp cotton wool

21
Q

How do we test dental dam seal?

A

By irrigating with CHX to ensure no leakage

22
Q

After dam placement what do we do?

A

get clinician to check dam

23
Q

What type of needle do we use for irrigation of canal?

A

Side vented Leur-lok 27G needle

24
Q

What do we attach leur-lok 27G needle to?

A

3ml syringe

25
Q

How fill do we fill syringes?

A

2/4 full to aid control

26
Q

What do we use on syringes?

A

silicon stop or bend needle 2mm short of working length

27
Q

How do we bring irrigating needle to pts mouth?

A

behind pts head - never over their face!!

28
Q

How do we deliver irrigant solution via the needle and syringe system?

A

We depress plunger with index finger rather than thumb to reduce pressure

BDS4 Endodontics (7 decks)

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