sodium-hypochlorite and Necrosis

A case is reported in which sodium hypochlorite (NaOCl) was mistaken for anaesthetic solution and infiltrated into the buccal mucosa during routine root canal treatment.. A 1.5% sodium hypochlorite solution, kept in an anaesthetic cartridge, was inadvertently injected in the buccal mucosa of a 56-year-old female during routine root canal treatment. Soft tissue necrosis, labial ptosis and paraesthesia occurred shortly after the injection. Tissues healed with scarring and lip paraesthesia persisted for 3 years.. * NaOCl is highly irritant when introduced into oral tissues. * NaOCl solutions should not be kept in anaesthetic cartridges. * Accidents with NaOCl should be carefully assessed and when appropriate active hospital treatment should be sought. * Early recognition of NaOCl accidents may avert potentially more serious outcomes.

Topics: Accidents; Anesthetics, Local; Female; Follow-Up Studies; Humans; Injections; Lip Diseases; Middle Aged; Mouth Mucosa; Necrosis; Paresthesia; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Vision Disorders

Dead tissue, in the form of slough and necrosis, can, if present in a wound, delay healing and promote infection. Debridement describes any method by which such materials are removed and, as a consequence, the potential to achieve wound healing enhanced. In this article, the first of two, the author discusses the history of debridement, cell death, the nature of necrotic tissue and a variety of debridement techniques. All methods of debridement have associated risks and benefits and while this article examines its clinical application there are also legal and professional issues to consider particularly in relation to conservative sharp debridement. These issues will be addressed in the second article.

Topics: Anti-Infective Agents, Local; Apoptosis; Bandages; Borates; Debridement; Humans; Hydrogen Peroxide; Necrosis; Povidone-Iodine; Risk Factors; Sodium Hypochlorite; Treatment Outcome; Wound Healing; Wounds and Injuries

This study aimed to comparatively evaluate the disinfecting potential of sodium hypochlorite, diode laser, and photodynamic therapy in non-vital teeth with or without periapical rarefaction. Forty-five patients with the diagnosis of pulp necrosis with apical rarefaction were randomly assigned to three groups (n = 15) based on the disinfection protocol. Access cavities were prepared and pre-instrumentation microbial samples were taken using a paper point. Working length determination followed by cleaning and shaping with rotary files was performed. The canals were lubricated with ethylenediaminetetraacetic acid (EDTA) during instrumentation and finally rinsed with copious amounts of saline. Canals in group 1 were irrigated with 5 mL of 5.25% NaOCl, those in group 2 received irradiation with 808-nm diode laser (30 s, 7W), and those in group 3 were soaked with methylene blue photosensitizer (5 min) before irradiation with 660-nm diode laser (3 min). Post-disinfection microbial samples were collected using a paper point. Pre- and post-disinfection live bacterial counts were analyzed using a flow cytometer. The data were statistically analyzed using one-way ANOVA and Student's t-test. Comparison of pre-instrumentation mean live bacterial count showed no significant difference between the groups (p > 0.05). The mean live bacterial count post-disinfection was 41.07%, 46.99%, and 34.45% in groups 1-3 respectively. A significant reduction in the bacterial count was seen following disinfection in all the groups (p < 0.05). It can be concluded that both diode laser and photodynamic therapy were equally effective as 5.25% NaOCl in reducing the bioburden in root canals. TRIAL REGISTRATION: CTRI/2018/03/012667.

Topics: Flow Cytometry; Humans; Lasers, Semiconductor; Necrosis; Photochemotherapy; Photosensitizing Agents; Sodium Hypochlorite

Topics: Female; Gastrectomy; Humans; Middle Aged; Necrosis; Sodium Hypochlorite; Stomach; Suicide, Attempted

To evaluate the cytotoxicity and the mechanism of cell aggression of peracetic acid (PA) in comparison with sodium hypochlorite (NaOCl).. L929 fibroblasts were exposed to 1% PA and 2.5% NaOCl, at several dilutions for 10 min. The following parameters were evaluated: cell metabolism by methylthiazol tetrazolium assay, external morphology by scanning electron microscopy, ultrastructure by transmission electron microscopy, the cytoskeleton by means of actin and α-tubulin labelling, and the type of cell death by flow cytometry (apoptosis/necrosis). The data were analysed by two-way anova and the Bonferroni post-test (α = 0.05).. The PA group had lower cell viability and a higher percentage of necrotic cells than the NaOCl group (P < 0.05). Both solutions diminished cell metabolism, led to destructuring of the cytoskeleton, created changes in the external morphology, resulted in the accumulation of proteins in the rough endoplasmic reticulum and induced cell death predominantly by necrosis. However, these changes were observed in lower doses of PA when compared with NaOCl.. Although they had the same mechanism of cytotoxicity, 1% PA had greater cytotoxic potential than 2.5% NaOCl.

Topics: Animals; Apoptosis; Cell Culture Techniques; Cell Line; Cell Survival; Cytoskeleton; Disinfectants; Fibroblasts; Flow Cytometry; Mice; Microscopy, Electron; Necrosis; Peracetic Acid; Sodium Hypochlorite

To compare the efficacy of sodium hypochlorite (NaOCl) used at different concentrations and working times for removing necrotic periodontal ligament (PDL) from delayed replanted teeth and to observe the effects of NaOCl on surface structure and microhardness of cementum.. A total of 88 healthy premolars with a single root extracted for orthodontic purposes were selected and kept dry at room temperature for 1 h. The teeth were divided into 11 groups: group 1 (control): roots were untreated; group 2: necrotic PDL was removed with gauze; groups 3-11: teeth were immersed in NaOCl at different concentrations (1, 2.5 and 5.25%) and for different working times (5, 10 and 15 min). The specimens in each group were inspected separately for cementum integrity and the presence of PDL remnants by histomorphometric analysis, confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Another 14 healthy premolars with roots divided into two pieces were selected for Vickers microhardness indentation tests before and after NaOCl treatment. The data were analysed statistically using Wilcoxon signed-rank test of two-related samples (P = 0.05).. In teeth treated with 1% NaOCl for 15 min or 5.25% NaOCl for 5 min, the cementum remained morphologically intact without cracks, and PDL remnants were absent. In the 1% NaOCl for 15 min group, the microstructure of cementum was arranged more regularly, as observed ×8000 magnification by SEM. Teeth in each of the other groups displayed cementum damage and/or the presence of PDL remnants. Microhardness tests revealed that treatment with 1% NaOCl for 15 min or 5.25% NaOCl for 5 min significantly decreased microhardness of root cementum (P < 0.05).. Use of either 1% NaOCl for 15 min or 5.25% NaOCl for 5 min was effective at removing necrotic PDL from the delayed replanted teeth whilst having a minimal influence on cementum integrity. However, 1% NaOCl for 15 min was less damaging to cementum.

Topics: Adolescent; Bicuspid; Dentin; Hardness; Humans; In Vitro Techniques; Microscopy, Confocal; Microscopy, Electron, Scanning; Necrosis; Periodontal Ligament; Sodium Hypochlorite; Surface Properties; Tooth Replantation

The extrusion of sodium hypochlorite through the apical foramen is an accident that can occur during the flushing procedure in endodontic treatment. The symptomatology is immediate and intense, and there is a long period before the tissues return to normal. Low-level laser therapy might be useful as an adjunctive treatment for damaged soft tissues because of its anti-inflammatory and analgesic effects, which may reduce edema and prevent infection. In this clinical case, the accidental leakage of 1% sodium hypochlorite during the preparation of the root canal of a maxillary right central incisor is reported. This leakage caused immediate and intense pain and edema formation and resulted in an extensive necrotic area in the alveolar mucosa adjacent to the root of the treated tooth. The conventional treatment protocol was combined with low-level laser therapy. Clinical and radiographic examinations after 7 months revealed complete repair of the necrotic area with no paresthesia and further indicated the integrity of the apical region of the tooth where the extrusion of sodium hypochlorite occurred. The combination of low-level laser therapy with a conventional treatment protocol in this case of the extrusion of 1% sodium hypochlorite resulted in the healing of the wounds.

Topics: Disinfectants; Female; Humans; Low-Level Light Therapy; Middle Aged; Mouth Mucosa; Necrosis; Radiography, Dental; Root Canal Preparation; Sodium Hypochlorite; Treatment Outcome

Sodium hypochlorite is widely used in dentistry as an intra-canal irrigant, for debridement and to disinfect root canals. Although it is considered to be safe, serious mishap can result from its inappropriate use, and this has been reported infrequently in the literature. Two unusual cases of sodium hypochlorite toxicity and their successful non-surgical management are described in a 14-year-old girl and a 13-year-old boy.

Topics: Adolescent; Dental Care; Female; Humans; Male; Mouth Mucosa; Necrosis; Skin Diseases; Sodium Hypochlorite

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

Sodium hypochlorite (bleach) is advocated as an irrigant for use in endodontic therapy for its bacteriocidal and tissue dissolving properties. Extrusion of hypochlorite into the surrounding soft and hard tissues, however, can lead to severe complications, as illustrated in our four case reports. This article considers the risk benefit ratio of the different materials available and advises dental practitioners to ensure patients are aware of the potential risks of the materials used when seeking informed consent. It also aims to provide some guidance on prevention, identification and management of incidents.

Topics: Adult; Burns, Chemical; Extravasation of Diagnostic and Therapeutic Materials; Facial Nerve Injuries; Female; Humans; Middle Aged; Necrosis; Oral Ulcer; Root Canal Irrigants; Sodium Hypochlorite; Trigeminal Nerve Injuries

Nanomaterials have been used to create new consumer products as well as applications for life sciences and biotechnology. The aim of this study was to evaluate the tissue response to implanted polyethylene tubes filled with fibrin sponge embedded with silver nanoparticles dispersion.. Thirty rats received individually 4 polyethylene tubes filled with sponge embedded in 47 ppm, 23 ppm silver nanoparticles dispersion, 2.5% sodium hypochlorite, or with no embedding as control. The observation periods were 7, 15, 30, 60, and 90 days. After each period of time, 6 animals were killed, and the tubes and surrounding tissue were removed, fixed, and prepared to be analyzed in light microscope with glycol methacrylate embedding, 3-μm serial cutting, and hematoxylin-eosin stain. Qualitative and quantitative evaluations of the reactions were performed.. Both materials caused moderate reactions at 7 days. The response was similar to the control on the 15th day with 23 ppm silver nanoparticles dispersion and 2.5% sodium hypochlorite and on the 30th day with 47 ppm silver nanoparticles dispersion.. It was possible to conclude that silver nanoparticles dispersion was biocompatible especially in a lower concentration.

Topics: Animals; Calcinosis; Connective Tissue; Drug Carriers; Fibrin; Male; Nanoparticles; Necrosis; Neutrophil Infiltration; Rats; Rats, Wistar; Root Canal Irrigants; Silver; Sodium Hypochlorite

The effects of chlorine dioxide (ClO2), sodium hypochlorite (NaOCl), and hydrogen peroxide (H2O2) on cell death and the cell cycle of human gingival fibroblast (HGF) cells were examined.. The inhibition of HGF cell growth was evaluated using a Cell Counting Kit-8. The cell cycle was assessed with propidium iodide-stained cells (distribution of cells in G0/G1, S, and G2/M phases) using flow cytometry. The patterns of cell death (necrosis and apoptosis) were analyzed using flow cytometry with annexin V-FITC/PI staining.. The lethal doses for 50% of the cells (LD50) of ClO2, NaOCl, and H2O2 were 0.16, 0.79, and 0.11 mM, respectively. All three dental disinfectants induced G0/G1 cell cycle arrest. H2O2 induced apoptosis at concentrations of 0.05 and 0.1 mM, while NaOCl and ClO2 did not induce significant apoptosis at any concentration examined.. These results suggest that ClO2 is sufficient for use as a dental disinfectant compared with H2O2 or NaOCl.

Topics: Apoptosis; Cell Count; Cell Cycle; Cell Death; Cell Division; Cells, Cultured; Chlorine Compounds; Fibroblasts; G1 Phase; G2 Phase; Gingiva; Humans; Hydrogen Peroxide; Lethal Dose 50; Materials Testing; Necrosis; Oxidants; Oxides; Resting Phase, Cell Cycle; Root Canal Irrigants; S Phase; Sodium Hypochlorite

A 58-year-old woman was referred by her dentist to a maxillofacial surgeon because of a rapidly increasing facial swelling. The swelling developed after sodium hypochlorite irrigation during the endodontic treatment of tooth 25. A mechanical heart valve, a heart rhythm disorder, and antithrombotic therapy were complicating medical conditions. Treatment consisted of 12 mg dexamethason administered once intravenously, augmentin administered thrice daily intravenously, and oral analgetics. Damage following sodium hypochlorite irrigation during endodontic treatment is a rare disorder which is associated with a severe reaction in the surrounding tissue. Damage can be permanent.

Topics: Amoxicillin-Potassium Clavulanate Combination; Dexamethasone; Facial Injuries; Female; Humans; Middle Aged; Mouth Mucosa; Necrosis; Root Canal Irrigants; Sodium Hypochlorite; Treatment Outcome

A case is reported in which sodium hypochlorite (NaOCl) was inadvertently injected into the palatal mucosa instead of local anaesthetic solution.. An adult male was referred to the University clinic 15 days after an inadvertent NaOCl injection into the palatal mucosa. Soft tissue necrosis was evident, without obvious bony involvement. Tissues healed without scarring within 30 days. No surgical intervention was required.. NaOCl is highly irritant when extruded into vital tissues.--Dentists should be careful to avoid the misuse of NaOCl, and should check the nature of any agent before injecting it into patients.--NaOCl should not be dispensed in a way that could allow it to be mistaken for local anaesthetic solutions.--The well-perfused tissues of the oral cavity have considerable healing ability.

Topics: Accidents; Adult; Anesthetics, Local; Humans; Injections; Irritants; Male; Medication Errors; Mouth Mucosa; Necrosis; Palate; Root Canal Irrigants; Sodium Hypochlorite

Endodontic therapy is a routinely practised clinical procedure with few reported complications. Sodium hypochlorite is often used as an irrigant during this procedure, but severe complications may occur if this solution extravasates beyond the root apex. We present a case demonstrating some of the severe sequelae that can occur following the misuse of sodium hypochlorite during endodontic treatment of an upper lateral incisor, which also resulted in the previously unreported complication of isolated facial nerve weakness.

Topics: Adult; Anti-Inflammatory Agents; Burns, Chemical; Dexamethasone; Extravasation of Diagnostic and Therapeutic Materials; Facial Injuries; Facial Nerve Injuries; Female; Humans; Injections, Intravenous; Mouth Mucosa; Necrosis; Root Canal Irrigants; Sodium Hypochlorite

To present a clinical case that illustrates the toxicity of concentrated sodium hypochlorite (NaOCl) on vital tissues.. The severe clinical consequences of extruding concentrated NaOCl into the periradicular tissues during root canal irrigation are described. After diagnosis of external resorption in tooth 34, endodontic treatment was initiated. Following irrigation with a concentrated NaOCl solution, a rapidly developing swelling and haematoma were visible. During the next few days, an extensive bruise and local necrosis of the oral mucosa developed. After healing of the involved tissues, the canal was prepared and obturated. At this time, no clinical symptoms remained.. * The use of concentrated NaOCl as a root canal irrigant might cause severe clinical problems when extruded into vital tissues. * The present report confirms the known toxicity of NaOCl to soft tissues following inadvertent extrusion. * To avoid extrusion, it is always prudent to confirm the length and integrity of the root canal system before irrigating with concentrated solutions.

Topics: Dental Pulp Cavity; Extravasation of Diagnostic and Therapeutic Materials; Female; Hematoma; Humans; Lip; Middle Aged; Mouth Mucosa; Necrosis; Odontometry; Root Canal Irrigants; Root Resorption; Sodium Hypochlorite

In this in vitro study, we investigated the efficacy of sodium hypochlorite (NaOCl) and calcium hydroxide (Ca(OH)2) in dissolving necrotic tissue and cleaning root canals. In the first part of the study, 0.5% NaOCl solution and Ca(OH)2 paste and solution were tested with samples of necrotic bovine muscle in different treatment modes and for different periods. The necrotic tissue was weighed before and after the test and the percentage of weight change calculated. In the second part of the study, 40 extracted single-rooted human teeth were hand instrumented and then subjected to different irrigation regimens. The cleansing efficacy in root canals of 0.5% NaOCl with Ca(OH)2 pretreatments and ultrasonics was examined using scanning electron microscopy. A solution of 5% NaOCl was significantly more effective than 0.5% NaOCl as a solvent of necrotic tissue. Calcium hydroxide was an effective solvent for necrotic tissue as a paste but not as a solution. Pretreatment of necrotic tissue with Ca(OH)2 increased its solubility in 0.5% NaOCl. While 5% NaOCl plus ultrasonic irrigation produced cleaner root-canal walls at the middle and apical thirds, 0.5% NaOCl used with the same technique achieved no root-canal cleaning. However, pretreatment of root canals with Ca(OH)2 paste increased the effectiveness of 0.5% NaOCl plus ultrasonic irrigation, except in the coronal third of the root canal.

Topics: Animals; Calcium Hydroxide; Cattle; Dental Disinfectants; Dental Pulp Cavity; Humans; In Vitro Techniques; Microscopy, Electron, Scanning; Muscles; Necrosis; Root Canal Preparation; Smear Layer; Sodium Hypochlorite; Therapeutic Irrigation; Ultrasonic Therapy

The method of indirect electrochemical detoxification by means of sodium hypochlorite (NaClO) obtained by isotonic NaCl solution electrolysis on a [symbol: see text] device consists in modeling hepatic monooxygenase detoxifying function on cytochrome B-450. Indirect electrochemical detoxification was conducted in more than 200 patients with generalized abdominal pyo-inflammatory processes and marked intoxication syndrome. Sodium hypochlorite was used for intravenous treatment of endotoxicosis in concentrations of 600 mg/l and 300 mg/l in volumes of 1/10 and 1/6 CBV in patients with generalized fibrinopurulent peritonitis and pancreonecrosis and for local administration during programmed prophylactic treatment of the abdominal cavity. The detoxifying effect was best in patients with grade 2-3-intoxication (according to V. K. Gostishchev et al., 1989). Local use of NaClO was marked by a high necrolytic effect, antiseptic properties, capability for reducing the resistance of the microflora to antibiotics, etc. The work discusses the methods of hypochlorite application, indications, contraindications, possible complications and their prevention.

Topics: Adult; Aged; Combined Modality Therapy; Electrolysis; General Surgery; Humans; Infusions, Intravenous; Middle Aged; Necrosis; Pancreatic Diseases; Peritonitis; Sodium Hypochlorite; Sorption Detoxification; Suppuration

A case of fatal poisoning in a 1-year-old girl after ingestion of a household cleanser containing 4.5% sodium hypochlorite (Klorin) in an alkaline solution (pH 12.0) is reported. The forensic medical and toxicological investigations were supplemented by animal studies. These studies indicate that 5, 10, and 15 ml of Klorin/kg body wt given to rats is highly toxic, and that local tissue damage and secondary systemic involvement develops with a severity corresponding to the amount administered. The rats, all of which died, showed various degrees of degeneration and necrosis of the esophagoventricular mucosus membranes, changes analogous to those found at the autopsy of the child. A follow-up investigation of similar cases reported to the Swedish Poison Information Centre, during a limited time, was made to complete the picture.

Topics: Accidents; Adolescent; Adult; Aged; Animals; Child; Child, Preschool; Esophagus; Female; Gastrointestinal Contents; Humans; Infant; Liver; Lung; Necrosis; Poisoning; Portal Vein; Rats; Sodium Hypochlorite; Stomach

Topics: Animals; Calcium Hydroxide; Muscles; Necrosis; Root Canal Irrigants; Sodium Hypochlorite; Swine

Topics: Animals; Hydrogen-Ion Concentration; Necrosis; Rabbits; Rheology; Sodium Hypochlorite; Surface Properties

Topics: Animals; Connective Tissue; Hot Temperature; Necrosis; Rats; Root Canal Therapy; Sodium Hypochlorite; Solvents

This study was carried out to answer the questions concerning the percentage of sodium hypochlorite needed to dissolve necrotic tissue and parachlorophenol- or formaldehyde-fixed necrotic tissue and the effect of the combined use of sodium hypochlorite and hydrogen peroxide. The results of this investigation indicate that a 3 percent concentration of sodium hypochlorite is optimum for the production of an adequate solvent action on necrotic tissue. A combination of sodium hypochlorite with 3 percent hydrogen peroxide did not result in an increased solvent action; therefore, their simultaneous use is not recommended.

Topics: Animals; Chlorophenols; Connective Tissue; Dental Pulp Necrosis; Fixatives; Formaldehyde; Hydrogen Peroxide; Necrosis; Rats; Root Canal Therapy; Sodium Hypochlorite; Solvents; Time Factors

Topics: Animals; Necrosis; Rats; Root Canal Therapy; Sodium Hypochlorite; Therapeutic Irrigation

The effect of some agents on the antimicrobial activity of ammoniacal silver nitrate, an endodontic medicament, was tested with Streptococcus faecalis by the serial tube dilution method. Its results indicated that sodium hypochlorite, hydrogen peroxide, and blood had a marked inhibitory effect. However, the presence of dentin, necrotic tissue, saliva, and hydrogen sulfide gas liberated from protein decomposition showed no or little effect on the antibacterial properties of the chemical. Since antiseptics or antibiotics generally may be decomposed by necrotic tissues, these findings suggested that the use of ammoniacal silver nitrate not only may resolve the problem of recalcitrant cases in endodontic treatment but also may simplify the disinfecting procedure for root canals.

Topics: Animals; Anti-Bacterial Agents; Blood; Blood Coagulation; Dental Pulp Cavity; Dentin; Enterococcus faecalis; Gingival Diseases; Goats; Humans; Hydrogen Peroxide; Hydrogen Sulfide; Necrosis; Quaternary Ammonium Compounds; Root Canal Therapy; Saliva; Silver Nitrate; Sodium Hypochlorite