Hypochlorite accident - Courtesy ROOTS

From: Steve
To: ROOTS
Sent: Friday, October 20, 2006 4:31 AM
Subject: Re: [roots] Hypochlorite Accident

Hi all, What is the protocol for dealing with a hypochlorite accident? - Steve

The best way is to prevent one, here is part of an old  ROOTS thread  (2001)  and Bill Watson’s recommendations :
( http://www.dentalindia.com/hypo.html )

I will look up an article for you on NAOCL2 accident and send it - Benjamin Schien

From: Jeevan Kumar Santiago
To: ROOTS
Sent: Tuesday, July 03, 2001 1:25 PM
Subject: [roots] the hypochlorite question

Though I use lot of hypochlorite ...hmmm... i am pretty scared about the product . I
wonder how come this product used for washing clothes landed up  washing the inside of
people's teeth ! Do you rooters use any standard protocol while using this dangerous /
hazardous product ? I have witnessed a hypochloride incident in my friend's office ..
BOOOO.. it was scary .. the patient's face was all swollen up and it resembled
something like cellulitis ! He was giving predisolone to control the acute
inflammation and he was even expecting larngospasm !

Is it a must that we have to continue using this product or is there any alternative
available ?

Jeevan, We are taught to suction the canal and flush with copious saline, Incise and drain if immediate diffuse
swelling, calm the patient, reanesthetize, give amoxicillin 500mg q6h for 7 days, 4 mg Decadron injected in the
vestibule near the tooth being worked on, 600 mg Ibuprofen q6h and finally narcotic pain meds of your choice.
Follow the patient closely and let them know the pain and swelling will subside in 2-3 days, but bruising could be
present for 2-3 weeks.

I am sure others will chime in here and I am interested to hear their opinions as well.

I have not had an accident(knock on wood) yet, but was covering the clinic when a student had one,Hope this helps - Josh

Article - courtesy Benjamin Schien

Hülsmann M, Hahn W. Complications during root canal irrigation literature review and case reports.
International Endodontic Journal, 33, 186193, 2000.

Literature review and case reports
The literature concerning the aetiology, symptomatology and therapy of complications during root canal irrigation is
reviewed. Three cases of inadvertent injection of sodium hypochlorite and hydrogen peroxide beyond the root apex are
presented. Clinical symptoms are discussed, as well as preventive and therapeutic considerations.

Symptomatology and therapy after inadvertent injection of NaOCl into the periapical tissues

Symptomatology

Immediate severe pain
Immediate oedema of neighbouring soft tissues
Possible extension of oedema over the injured half side of the face, upper lip, infraorbital region
Profuse bleeding from the root canal
Profuse interstitial bleeding with haemorrhage of the skin and mucosa (ecchymosis)
Chlorine taste and irritation of the throat after injection into the maxillary sinus
Secondary infection possible
Reversible anaesthesia or paraesthesia possible

Therapy

Patient information on cause and severity of complication
Pain control: local anaesthesia, analgesics
In severe cases: referral to a hospital
Extraoral cold compresses for reduction of swelling
After 1 day: warm compresses and frequent warm mouthrinses for stimulation of local systemic circulation
Daily recall for control of recovery
Antibiotics: not obligatory. Only in cases of high risk or evidence of secondary infection
Antihistamine: not obligatory
Corticosteroids: controversial

Further endodontic therapy with sterile saline or chlorhexidine as root canal irrigants

Right on Ben...In my haste to respond, I left out the need for the cold followed by warm compresses.Thanks, Josh

I remember a very nasty hypochlorite accident pic presented once on Roots....Plz. a repost by someone would serve
as a good reminder to be extremely careful - Sachin