Managemnent Of Extrusion Of Sodium Hypochlorite

Question 1

What features make sodium hypochlorite extrusion high risk?

Answer 1

Open apices of RC

Perforation of the RC

Close proximity to surrounding structures such as maxillary antrum

Teeth with unclear root angulation

Question 2

What are the signs / symptoms of sodium hypochlorite extrusion?

Answer 2

Severe pain of sudden onset - minutes to hours to develop

Large and diffuse swelling

Profuse haemorrhaging through root canal

Irritant flow from nostrils with burning pain (maxillary antrum)

Taste of hypochlorite

Epistaxis

Question 3

SOP for extrusion of hypochlorite?

Answer 3

Stop ALL treatment immediately
- advise pt of what’s happened
- consider LA for pain relief
- allow haemorrhage until haemostasis achieved
- steroid containing intra-canal medicament placed in
- seal coronal access but dont obturate
- review 24 hours

Question 4

Post op advice for endodontic tx?

Answer 4

Consider prescription of NSAIDS / paracetamol

Consider antibiotic prescription where high risk of bone / tissue necrosis

Review 24 hours

Referral to OMFS if mucosal or bone necrosis / sensory defects pr motor nerve defects