ABSTRACT
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.
Subject(s)
Pulpectomy/adverse effects , Root Canal Irrigants/adverse effects , Sodium Hypochlorite/adverse effects , Anesthesia, Dental , Anesthesia, General , Dental Caries/therapy , Dental Pulp Exposure/therapy , Ecchymosis/etiology , Edema/etiology , Facial Dermatoses/etiology , Humans , Incisor/surgery , Infant , Maxilla/pathology , Pulpitis/therapy , Tooth, Deciduous/surgeryABSTRACT
To better understand the etiology associated with sodium hypochlorite accidents, we surveyed diplomates of the American Board of Endodontics. Of the 314 diplomates who responded, 132 reported experiencing a sodium hypochlorite accident. Questions were asked about the age and sex of the patient as well as the tooth being treated, preoperative signs, symptoms, diagnosis, and radiographic appearance. Data were analyzed by chi-square tests. Significantly more women experienced sodium hypochlorite accidents compared with men (p < 0.0001). More maxillary teeth than mandibular teeth (p < 0.0001) and more posterior than anterior teeth (p < 0.0001) were involved. A diagnosis of pulp necrosis with radiographic findings of periradicular radiolucency were positively associated with such accidents (p < 0.0001). Most respondents reported that patient signs and symptoms completely resolved within a month. The occurrence of an accident, by itself, did not adversely affect the endodontic prognosis of the involved tooth. Anatomic variations may contribute significantly to the occurrence of a sodium hypochlorite accident.
Subject(s)
Endodontics , Extravasation of Diagnostic and Therapeutic Materials/etiology , Root Canal Irrigants/adverse effects , Root Canal Preparation/adverse effects , Sodium Hypochlorite/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Alveolar Bone Loss/pathology , Bicuspid , Female , Humans , Male , Maxilla , Middle Aged , Molar , Young AdultABSTRACT
Sodium hypochlorite (NaOCl) in various concentrations is the most widely used endodontic irrigant, but it can be an irritant to vital tissues. There are several reports about the complications of irrigation with NaOCl during root canal therapy. Most of the complications are the result of accidental extrusion of the solution from the apical foramen or accessory canals or perforations into the periapical area. This article is a review and comparison of all reported NaOCl accidents in the literature.
Subject(s)
Root Canal Irrigants/adverse effects , Sodium Hypochlorite/adverse effects , Accident Prevention , Burns, Chemical/etiology , Burns, Chemical/therapy , Extravasation of Diagnostic and Therapeutic Materials/prevention & control , Humans , Root Canal Irrigants/administration & dosage , Sodium Hypochlorite/administration & dosageABSTRACT
Endodontic disease is mediated by bacteria. Treatment goals should be directed to reducing the critical concentration of microbial irritants to the lowest level possible. Thorough canal instrumentation, with either stainless steel hand files or Ni-Ti rotary files, removes the bulk of tissue and microbial contamination, but adjunctive chemical agents are needed to optimize debridement. Current concepts support the following approaches: lubricating and chelating agents during cleaning and shaping; copious irrigation during all phases of instrumentation with 2.5% sodium hypochlorite, constantly refreshed; deep penetration of a side port, narrow gauge irrigating needle, constantly moving in and out of the canal space during each irrigation; removal of residual smear layer at completion of instrumentation prior to obturation.
Subject(s)
Dental Pulp Cavity/microbiology , Periapical Periodontitis/prevention & control , Root Canal Irrigants/administration & dosage , Root Canal Therapy/methods , Humans , Root Canal Therapy/instrumentationABSTRACT
The purpose of this study was to evaluate the concept that novice clinicians could perform clinical endodontics better and more efficiently if the stainless steel hand file technique is replaced with a nickel titanium rotary file technique. In phase 1 of the study, every endodontic case performed by 2 groups was evaluated for total treatment time. In phase 2, the mesial roots of mandibular molars were evaluated for radiographic quality of completed obturation. The authors found that when the rotary file technique was substituted for the hand file technique, appointment time for case completion was significantly decreased (P<.001) and overall radiographic quality of mandibular molar mesial root obturation was significantly increased (P=.0009). These results support the hypothesis that novice clinicians can perform endodontic therapy more efficiently when using a nickel titanium rotary file technique. In addition, no differences were noted in the incidence of file fracture when using rotary instruments.
