Safe
use of Sodium Hypochlorite as an Irrigant
The use of sodium hypochlorite
(NaOCl) also known as 5.25% Clorox bleach is an important element
in contemporary endodontic treatment. Combined with the mandatory
use of a rubber dam, full strength NaOCl can be the most critical
element in successful endodontic therapy.
There
is an overwhelming amount of clinical research reporting that
NaOCl is required to dissolve tissue contained in microscopic
spaces. 5.25% NaOCl is
very basic (pH 12.02) and very toxic.
Inadvertent extrusion (sodium hypochlorite accident) of
NaOCl through the apex of the tooth and into the surrounding tissues
can have dramatic inflammatory consequences and must be avoided.
In the month of March, we had two calls from general dentists
concerning sodium hypochlorite accidents.
The two most common causes of an accident are (1) excessive
pressure during irrigation and (2) wedging the irrigation needle
in the canal.
Contraindications for NaOCl use:
·
Pediatric
teeth, both deciduous and young permanent teeth with open apices
·
Roots
with obvious large radiographic external resorptive defects
·
Roots
of maxillary molars with open apices in close proximity to the
sinus
Recognizing an accident:
·
If the patient complains of pain during an endodontic
procedure and you are using NaOCl but not actively instrumenting
the tooth, immediately dilute the canals and investigate.
·
If
any rapid swelling or tissue discoloration occurs, immediately
stop and remove the NaOCl.
Avoiding an accident:
·
Use
only Luer Lock needles that are side vented or Vista Probe and
Max-I-Probe type needles that are closed ended with side-port
delivery. Deliver the NaOCl with a stirring and pumping type motion. Keep the syringe in motion to prevent it from
wedging in the canal.
Treatment:
·
Treatment
will be palliative and protective because NaOCl cannot be drained
·
Immediately
irrigate the canal with sterile saline to dilute the NaOCl
·
Stop
treatment and immediately explain to the patient what is happening
·
Inject
a long acting anesthetic but in an area remote or posterior to
the treated tooth
·
Prescribe
a strong narcotic analgesic for pain control, ice the first day,
heat the following days
·
Appropriate
antibiotics: Penicillin, Cleocin if allergic, place a drain for
3-5 days
·
Follow
the patient daily and , if possible, photo document with patient
consent
An excellent alternative for NaOCl is 0.12% chlorhexidine (Peridex).
Although it has no tissue dissolution property, it will provide
substantive anti-bacterial activity. Research is currently being
conducted on an endodontic irrigant that may revolutionize the
way we attempt to sterilize canals.
Summary: Use
the time that you save instrumenting the tooth and “invest” in
soaking the spaces with NaOCl for maximum tissue dissolution.
Remember: vital – dense collagenous connective tissue takes longer
to dissolve than necrotic tissue. Follow the guidelines for the
safe use of NaOCl and be confident that your cases are cleaner
and prepared for a successful outcome. Please do not hesitate
to call us or refer patients for evaluation if you have problems
with sodium hypochlorite.
ESCONDIDO
ENDODONTICS 488 EAST VALLEY PARKWAY SUITE 307 ESCONDIDO, CA 92025
(760) 739-1400
FAX (760) 739-1100 www.escoendo.com
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