Sodium Hypochlorite Accidents During Root Canal Treatment

Sodium hypochlorite (NaOCl) can be commonly found in a dentist's office. It is used as an irrigant during root canal treatments as it dissolves organic soft tissue of pulp and predentin. It is usually used in a dilution of 0.5% or less. Higher concentrations of sodium hypochlorite are cytotoxic. It has a foul chlorine smell and taste. When sodium hypochlorite extends through the periapex of the tooth and comes in contact with the periapical tissues, it causes acute inflammation followed by necrosis.

Sodium Hypochlorite Accident:

If the patient experiences a sudden severe pain during the root canal procedure, we must suspect a sodium hypochlorite accident. The signs and symptoms include:

• Edema (swelling with fluid accumulation).

• Ecchymosis (discoloration of the skin due to bleeding from underneath).

• Profuse bleeding from the root canal of the tooth.

• The patient may experience the smell of chlorine, severe pain, numbness, etc.

• The severity of the damage depends on the pH of the solution and duration of exposure.

How does a Dentist Manage NaOCl Accidents?

• Recognition of the problem early: the dentist informs the patient immediately about the accident.

• Irrigates the root canal immediately with normal saline. This dilutes the NaOCl and reduces the severity.

• Allows bleeding to occur which helps flush out the irritants.

• Reassures patient that things are under control.

• Explains to the patient how he/she can manage at home and preferably gives written instructions for home care. It is also important to monitor the patient on a daily basis.

• Palliative care: cold and warm compresses, saline rinses, pain control, prophylactic antibiotics and steroids if required.

How can a Dentist Avoid NaOCl Accidents?

• Always prepare an adequate access into root canal.

• Good working length: make sure that you it is not overextended.

• Make sure the irrigation needle is placed 1-3 mm short of the working length and that the needle is not locked in the canal.

• Flush the canal slowly with the irrigant by moving the needle constantly in and out.

• During the procedure, observe if the solution flows out during irrigation.

• Use of irrigant needles with side venting specifically designed for endodontic purpose minimizes the accidents.

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