Endo: Sodium Hypochlorite Accident

Question 1

SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT

What are the disadvantages of NaOCl irrigant ?

Answer 1

Toxic.
Lacks effect on inorganic materials.

Question 1

SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT

What is the properties of NaOCl which make it a beneficial irrigant for endodontic treatment ?

Answer 1

Bactericidal.
Dissolves organic components of smear layer and pulpal remnants.
Lowers dentine’s modulus of elasticity and flexural stength.

Question 2

SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT

What are the risks associated with a SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT ?

Answer 2

Hard/soft tissue irritation, necrosis, nerve damage.

Question 3

SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT

What are the symptoms of a SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT ?

Answer 3

• Severe pain with sudden onset.
• Large diffuse swelling.
• Profuse bleeding - through RC or periradicular.
• Epitaxis.
• Irrigant coming through nose - maxillary sinus communication.

Question 4

SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT

How does a SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT occur ?

Answer 4

• Extrusion of irrigant beyond point of apex into periradicular tissues.
• Causes irritation to tissues.
• Strong alkaline material pH>11.

Question 5

SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT

How can a SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT be prevented ?

Answer 5

• Use of apex locator - 2mm short of CWL.
• Pre-operative radiograph.
• Rubber dam with Opalseal.
• Rubber stop on needle.
• Negative pressure endo systems.

Question 6

SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT

How should you manage a SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT immediately ?

Answer 6

1. Make patient aware.
2. Give LA.
3. Irrigate with saline for 15 mins.
4. Achieve haemostasis.
5. Dress canal with non-setting CaOH.
6. Record in notes.
7. Complete DATIX.
8. Agree to review in 24 hours.

Question 7

SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT

What post-op instructions should you give a patient after a SODIUM HYPOCHLORITE (3% NaOCl) ACCIDENT ?

Answer 7

• Analgesia.
• Hot/cold compress to reduce swelling.
• Signs of worsening symptoms to go to A&E.