sodium-hypochlorite and Edema

Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur.. To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavour to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed.. By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-collapsible venous sinusoids within the cancellous bone is presented.. Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal débridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system.

Topics: Accidents; Ecchymosis; Edema; Extravasation of Diagnostic and Therapeutic Materials; Facial Dermatoses; Humans; Root Canal Irrigants; Sodium Hypochlorite

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

Aqueous sodium hypochlorite (bleach) solution is widely used in dental practice during root canal treatment. Although it is generally regarded as being very safe, potentially severe complications can occur when it comes into contact with soft tissue. This paper discusses the use of sodium hypochlorite in dental treatment, reviews the current literature regarding hypochlorite complications, and considers the appropriate management for a dental practitioner when faced with a potentially adverse incident with this agent.

Topics: Contusions; Edema; Eye Injuries; Humans; Occupational Health; Root Canal Irrigants; Sodium Hypochlorite

The effects of an inadvertent injection of sodium hypochlorite into the cheek during irrigation of the right maxillary central incisor root canal are reported. The patient suffered from severe pain, edema, and necrosis of subcutaneous tissues and mucosa. Surgical intervention was necessary to contain the destructive process which extended from the upper lip to the right eye. The histopathological examination demonstrated the high cytotoxicity of sodium hypochlorite on vital tissue.

Topics: Adult; Burns, Chemical; Cheek; Edema; Facial Pain; Female; Humans; Iatrogenic Disease; Root Canal Irrigants; Sodium Hypochlorite

The main objective of the present study is to evaluate the effects and possible benefits with regard to the postoperative period of lower third molar extractions, comparing the intraalveolar application of a bioadhesive gel of 0.2% chlorhexidine (CHX) to the use of a mouthwash with a super-oxidized solution, (SOS) Dermacyn® Wound Care (Oculus Innovative Sciences lnc., California, USA).. A randomized double-blind study was carried out in 20 patients with a split-mouth design, with a total of 40 extractions of symmetrically impacted bilateral lower third molars. Patients were divided into two groups, a control group (C = 20) and an experimental group (D = 20). Any infectious complications, wound healing, plaque accumulation in the stitches, and presence of trismus and inflammation were evaluated using the distance between different facial points, at three, eight, and fifteen days after extraction. Pain, swelling, and amount of analgesics taken were evaluated using the VAS scale throughout the 15 days following extraction. Tolerance to treatment was evaluated using a verbal scale. Results were statistically compared using the Student's t- and chi-squared tests.. No statistically significant differences were found between the two groups with regard to infectious complications, swelling, or wound healing. Use of analgesics and self-reported pain levels were slightly lower in the experimental group than in the control group during days 6 and 7 of the study (p < 0.05). The global treatment tolerance was satisfactory and similar in both groups.. Both CHX and SOS are effective at improving the postoperative period after extraction of lower third molars.

Topics: Adult; Chlorhexidine; Double-Blind Method; Drug Combinations; Edema; Female; Gels; Humans; Hypochlorous Acid; Male; Mandible; Molar, Third; Mouthwashes; Pain, Postoperative; Postoperative Complications; Prospective Studies; Sodium Hypochlorite; Tooth Extraction; Wound Healing

The purpose of this study was to compare the patient's postoperative discomfort when root canal irrigation was performed either with standard sodium hypochlorite or with sodium hypochlorite with the adjunct of a proteolytic enzyme.. Two hundred patients were endodontically treated in two clinics. The type of irrigant to be used during root canal instrumentation was randomly assigned. Final irrigation was done using EDTA 17%. The canals were filled by warm vertical condensation with guttha-percha and the coronal seal was made using IRM. Patients were given a questionnaire to assess pain and swelling and the number of analgesics and other drugs taken during the first week after treatment.. A total of 166 questionnaires could have been evaluated. No significant difference was found between groups for pain, swelling and analgesics taken. Moderate pain and swelling was reported only in the first two days after treatment. No antibiotics use was reported. No guttha-percha excess beyond root apex was found by radiographic assessment.. The irrigating solution containing a proteolytic enzyme does not produce greater postoperative discomfort as compared to the conventional sodium hypochlorite in patients undergoing endodontic therapy.

Topics: Adult; Analgesics; Edema; Humans; Pain, Postoperative; Pulpectomy; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Subtilisin; Surveys and Questionnaires; Treatment Outcome

A 66-year-old female patient presented to the accident and emergency department, 3 h following a dental appointment. Significant right-sided facial swelling, bruising and pain were present. The patient had been sent by her general dental practitioner with a covering letter explaining that a hypochlorite accident had occurred during root canal treatment of the upper right first premolar tooth. An iatrogenic perforation was suspected. The patient was admitted under the care of the maxillofacial team and intravenous antibiotics, analgesia and steroids were administered. The patient was prepared for the possibility of requiring surgical intervention under a general anaesthetic. No nerve injury was encountered and the periorbital tissues were spared. A full recovery was made by the patient with no surgical intervention required but significant bruising and swelling were present up to 4 weeks following the incident.

Topics: Acetaminophen; Aged; Amoxicillin-Potassium Clavulanate Combination; Analgesics, Non-Narcotic; Anti-Inflammatory Agents; beta-Lactamase Inhibitors; Cone-Beam Computed Tomography; Dexamethasone; Edema; Facial Pain; Female; Humans; Iatrogenic Disease; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Tooth Apex; Treatment Outcome

The high frequency of iatrogenic incidents during endodontic treatment is a source of stress for the practitioner. These incidents may occur during the different steps of a root canal treatment. During irrigation, extrusion of sodium hypochlorite beyond the apex is a rare but impressive accident. Sodium hypochlorite, is the most common irrigant used in modern endodontics, but when it comes in contact with the periapical tissue, it can cause complications ranging from mild discomfort to serious tissue damage such as the hematoma and hemato-emphysema. The aims of this article are to discuss through the presentation of two clinical cases: Etiological and predisposing factors; Signs guiding to suspicion of accidental injection of sodium hypochlorite. In this work, we focused on clinical keys that help the practitioner in better understanding this accident in order to prevent it or to manage it well when it occurs.

Topics: Accidents; Adult; Edema; Face; Female; Hematoma; Humans; Iatrogenic Disease; Injections; Male; Periapical Tissue; Root Canal Irrigants; Sodium Hypochlorite; Subcutaneous Emphysema

Sodium hypochlorite (bleach) is commonly used as an irrigant during dental procedures as well as a topical antiseptic agent. Although it is generally safe when applied topically, reports of accidental injection of sodium hypochlorite into tissue have been reported. Local necrosis, pain and nerve damage have been described as a result of exposure, but sodium hypo-chlorite has never been implicated as a cause of an acute kidney injury (AKI). In this report, we describe the first case of accidental sodium hypochlorite injection into the infraorbital tissue during a dental procedure that precipitated the AKI. We speculate that oxidative species induced by sodium hypochlorite caused AKI secondary to the renal tubular injury, causing mild acute tubular necrosis.

Topics: Acute Kidney Injury; Dental Caries; Ecchymosis; Edema; Humans; Iatrogenic Disease; Injections; Kidney Tubules; Medication Errors; Oxidants; Sodium Hypochlorite

Sodium hypochlorite (NaOCl) is most commonly used as an irrigating solution in endodontic practice. This paper describes an incident of sodium hypochlorite extrusion past the apex (SHEPA) of the UR3. Management of the condition resulted in hospitalisation of the patient, and intravenous antibiotic and steroid therapy. This case report details the measures that can be employed to reduce the risk of SHEPA and management of its potentially serious complications. The reader should understand the various measures that can be adopted to reduce extrusion of endodontic irrigants beyond the root apex and management following SHEPA.

Topics: Amoxicillin; Anti-Bacterial Agents; Dexamethasone; Diplopia; Edema; Extravasation of Diagnostic and Therapeutic Materials; Facial Pain; Female; Glucocorticoids; Humans; Middle Aged; Periapical Tissue; Root Canal Irrigants; Sodium Hypochlorite; Tooth Apex

A sodium hypochlorite accident is a rare event in adults, but even more so in children. The purposes of this paper were to: report the case of a one-year, 10-month-old toddler who was treated under general anesthesia for early childhood caries, incurred a sodium hypochlorite accident following attempted pulpectomy in his primary maxillary central incisors, but made a full recovery without any sequelae after a typical four to six weeks course of disease; review the pertinent literature; and give recommendations on how to minimize the potential occurrence of such incidents.

Topics: Anesthesia, Dental; Anesthesia, General; Dental Caries; Dental Pulp Exposure; Ecchymosis; Edema; Facial Dermatoses; Humans; Incisor; Infant; Maxilla; Pulpectomy; Pulpitis; Root Canal Irrigants; Sodium Hypochlorite; Tooth, Deciduous

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.

Topics: Adult; Cheek; Cone-Beam Computed Tomography; Edema; Exudates and Transudates; Facial Pain; Female; Follow-Up Studies; Humans; Periapical Tissue; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Subcutaneous Tissue; Tooth Apex

Topics: Adult; Cheek; Disinfectants; Ecchymosis; Edema; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Necrosis; Orbit; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite

Topics: Airway Obstruction; Burns, Chemical; Edema; Epiglottis; Esophagus; Humans; Hypopharynx; Sodium Hypochlorite; Stomach; Suicide, Attempted

The objective of this prospective clinical study was to evaluate the incidence of flare-ups (pain and/or swelling requiring endodontic interappointment and emergency treatment) and identify the risk factors associated with their occurrence in patients who received endodontic treatment from June 2006 to June 2007 at the endodontics clinic of the São Paulo Dental Association (APCD), Jardim Paulista branch, São Paulo, Brazil. The incidence of flare-ups was 1.71% out of 408 teeth that had received endodontic therapy. Statistical analysis using the chi-squared test (P < .05) indicated a direct correlation between the flare-up rate and the presence of a periradicular radiolucency.

Topics: Adult; Brazil; Edema; Edetic Acid; Emergency Treatment; Female; Humans; Incidence; Male; Middle Aged; Pain, Postoperative; Periapical Diseases; Postoperative Complications; Prospective Studies; Retreatment; Risk Factors; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Toothache; Young Adult

Topics: Adult; Ecchymosis; Edema; Face; Female; Hematoma; Humans; Root Canal Irrigants; Sodium Hypochlorite; Tomography, X-Ray Computed

Sodium hypochlorite solution is toxic to vital tissues, causing severe effects if extruded during endodontic treatment. This paper presents a report on the tissue damage related to inadvertent extrusion of concentrated sodium hypochlorite solution during root canal treatment. A 65-year-old woman was referred with moderate pain, ecchymosis, and severe swelling of the right side of the face. These symptoms appeared immediately after a root canal treatment of the maxillary right canine, which had been started 21 hours earlier. It was diagnosed as air emphysema related to sodium hypochlorite solution extravasation during the endodontic treatment. To avoid this, an initial radiograph should be taken to determine the correct canal working length and confirm root canal integrity.

Topics: Aged; Dental Fistula; Ecchymosis; Edema; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Periapical Abscess; Periapical Tissue; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Subcutaneous Emphysema

Sodium hypochlorite (NaOCl) is currently used in the debridement and disinfection of the root canal system, supporting the mechanical procedures. Although it is considered a safe irrigant, the literature reports a few cases of adverse reaction caused by NaOCl: They range from injection through the apical foramen to air emphysema and allergic reactions as complications during endodontic treatment. The present report shows the possible severe clinical consequences of concentrated NaOCl extruding through the periapical tissues during root canal irrigation in a patient not allergic to NaOCl.

Topics: Adult; Cheek; Ecchymosis; Edema; Female; Humans; Incisor; Lip; Maxilla; Mouth Mucosa; Periapical Tissue; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite

An unusual case is reported of accidental extrusion of sodium hypochlorite solution into the maxillary sinus during instrumentation in the course of root canal treatment of a maxillary premolar. This caused a burning sensation accompanied by nasal bleeding, swallowing of blood, and interrupted breathing. The case was managed by irrigating with sterile saline, arresting nasal bleeding, and administering antibiotics, anti-inflammatory drugs, and decongestants.

Topics: Adult; Edema; Epistaxis; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Maxillary Sinus; Root Canal Irrigants; Sodium Hypochlorite; Therapeutic Irrigation

Sodium hypochlorite (NaOCl) is a well documented and widely accepted intracanal irrigant used to disinfect the pulp space in endodontic therapy. NaOCl can be an extremely cytotoxic material; therefore, care must be taken with its use. The authors present a case of periradicular extravasation of NaOCl with sequelae of pain, swelling, ecchymosis and parasthesia consistent with a chemical burn. The patient was treated with a nonsurgical medical management approach. She experienced a complete resolution of signs and symptoms, aside from a persistent residual focal parasthesia.

Topics: Bicuspid; Burns, Chemical; Ecchymosis; Edema; Extravasation of Diagnostic and Therapeutic Materials; Face; Female; Humans; Maxilla; Middle Aged; Paresthesia; Periapical Tissue; Root Canal Irrigants; Sodium Hypochlorite

A previously undocumented complication of root canal therapy is reported. A dilute solution of 5-10 mls sodium hypochlorite was inadvertently injected into the maxillary sinus during root canal therapy of a right upper second premolar (5). The patient developed acute, sudden, severe facial pain and swelling necessitating emergency admission to hospital and operative intervention under general anaesthesia. A diagnosis of acute chemical sinusitus was made, further management and discussion follow.

Topics: Accidents; Acute Disease; Adult; Anti-Infective Agents, Local; Bicuspid; Edema; Facial Pain; Humans; Injections; Male; Maxillary Sinus; Maxillary Sinusitis; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite

Topics: Ecchymosis; Edema; Face; Female; Humans; Middle Aged; Root Canal Therapy; Sodium Hypochlorite

Sodium hypochlorite is a useful adjunct to endodontic therapy but it must be confined to the root canal. A case of periapical injection of hypochlorite with untoward sequellae is presented.

Topics: Ecchymosis; Edema; Humans; Male; Middle Aged; Periapical Tissue; Root Canal Irrigants; Sodium Hypochlorite

Topics: Animals; Edema; Erythrocytes; Eye; Female; Hemolysis; Hemorrhage; Humans; Male; Rabbits; Rats; Skin; Skin Diseases; Sodium Hypochlorite

Topics: Adult; Anesthesia, Dental; Edema; Female; Humans; Mouth Diseases; Nerve Block; Sodium Hypochlorite

Topics: Acetaminophen; Adult; Brompheniramine; Dental Caries; Edema; Female; Humans; Iatrogenic Disease; Oral Hemorrhage; Periapical Tissue; Periodontal Diseases; Pulpectomy; Root Canal Obturation; Root Canal Therapy; Sodium Hypochlorite; Tetracycline; Therapeutic Irrigation

Topics: Alkalosis; Bicarbonates; Burns, Chemical; Coma; Edema; Humans; Hyperglycemia; Hypernatremia; Infant; Insulin; Insulin Secretion; Male; Peritoneal Dialysis; Sodium; Sodium Hypochlorite; Water-Electrolyte Balance