sodium-hypochlorite and Cranial-Nerve-Diseases

Root canal treatment is performed routinely in dental practice, using sodium hypochlorite which serves as an effective irrigant. The literature reviewed shows that several complications following irrigation with sodium hypochlorite may occur, but few practitioners are aware of it and its management. Such complications include injury to skin, oral mucosa and eyes, damage to clothing, air emphysema, allergic reactions, and injection beyond the foramen. In this article, a case report of injection with sodium hypochlorite beyond the foramen is presented, together with a review of the recent literature regarding common manifestations and case histories. The literature shows no standard management of this condition, but symptomatic therapies are discussed. It is important to minimize the risk of sodium-hypochlorite-induced damage during root canal therapy by use of protective measures, appropriate instrumentation and techniques, and consider alternate irrigation solutions.

Topics: Cranial Nerve Diseases; Edema; Facial Paralysis; Female; Humans; Maxillary Nerve; Middle Aged; Paresthesia; Periapical Tissue; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Subcutaneous Emphysema

Endodontic therapy is a routinely practised clinical procedure with few reported complications but, as a bleaching agent, inadvertent spillage of sodium hypochlorite beyond the root canal system may result in extensive soft tissue or nerve damage, and even airway compromise. Although very rare, complications arising from hypochlorite extrusion beyond the root apex are described. NaOCl causes oxidation of protein and lipid membrane and causes necrosis, hemolysis and dermal ulcerations (2-4). Neurological complication are very rare. Paraesthesia and anaesthesia may affect the mental, inferior dental and infra-orbital branches of the trigeminal nerve and normal sensation may take many months to  completely resolve (6, 7). Nerve damage (the buccal branch) was described in 2005 by Witton et al. (8) and patients exhibited a loss of the naso-labial groove and a down turning of the angle of the mouth and the motor function was regained after several months. We present a case in which the extrusion of NaOCl solution during endodontic therapy led to important destructive effects on soft tissues and nerves. The arisen medico legal issues are discussed.

Topics: Adult; Blepharospasm; Cranial Nerve Diseases; Extravasation of Diagnostic and Therapeutic Materials; Facial Nerve Injuries; Female; Humans; Paresthesia; Root Canal Irrigants; Sodium Hypochlorite