COMPLICATIONS OF Sodium Hypochlorite Accident
1) Damage to clothing
Accidental spillage of sodium hypochlorite
is probably the most common
accident to occur during root canal irrigation.
Even spillage of minute quantities
of this agent on clothing will lead to
rapid, irreparable bleaching. The patient
should wear a protective plastic bib, and
the practitioner should exercise care
when transferring syringes fi lled with
hypochlorite to the oral cavity.
2) Eye damage
Seemingly mild burns with an alkali
such as sodium hypochlorite can result
in signifi cant injury as the alkali reacts
with the lipid in the corneal epithelial
cells, forming a soap bubble that
may be blurring of vision and patchy
colouration of the cornea.
Immediate
ocular irrigation with a large amount of
water or sterile saline is required followed
by an urgent referral to an ophthalmologist.8
The referral should ideally be made
immediately by telephone to the nearest
eye department. The use of adequate eye
protection during endodontic treatment
should eliminate the risk of occurrence
of this accident, but sterile saline should
always be available to irrigate eyes
injured with hypochlorite. It has been
advised that eyes exposed to undiluted
bleach should be irrigated for 15 minutes
with a litre of normal saline.
3) Damage to skin
Skin injury with an alkaline substance
requires immediate irrigation with water
as alkalis combine with proteins or fats in
tissue to form soluble protein complexes
or soaps. These complexes permit the
passage of hydroxyl ions deep into the
tissue, thereby limiting their contact with
the water dilutant on the skin surface.
Water is the agent of choice for irrigating
skin and it should be delivered at low
pressure as high pressure may spread the
hypochlorite into the patient’s or rescuer’s
eyes.
4) Damage to oral mucosa
Surface injury is caused by the reaction
of alkali with protein and fats as
described for eye injuries above. Swallowing
of sodium hypochlorite requires
the patient to be monitored following
immediate treatment. It is worth noting
that skin damage can result from secondary
contamination.
_______
COMPLICATIONS ARISING FROM
HYPOCHLORITE EXTRUSION BEYOND
THE ROOT APEX
1) Chemical burns and tissue necrosis
When sodium hypochlorite is extruded
beyond the root canal into the periradicular
tissues, the effect is one of
a chemical burn leading to a localised
or extensive tissue necrosis.
2) Neurological complications
Paraesthesia and anaesthesia affecting
the mental, inferior dental and infraorbital
branches of the trigeminal
nerve following inadvertent extrusion
of sodium hypochlorite beyond the root
canals have been described. Normal sensation
may take many months to completely
resolve.
3) Upper airway obstruction
The use of sodium hypochlorite for root
canal irrigation without adequate isolation
of the tooth can lead to leakage of the
solution into the oral cavity and ingestion
or inhalation by the patient
_______
What should I do if I suspect a hypochlorite
complication?
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15 окт 2024
