Sodium hypochlorite accident—complications, management and potential prevention: a report of three cases

Abstract

Background: Sodium hypochlorite (NaOCl) is a powerful irrigant for endodontic treatment. But, when extruded beyond the root apex, it becomes cytotoxic to patient’s tissues causing NaOCl accidents. The complications include ulceration to the soft tissues and irritation of nerves causing long term symptoms. Being under- or poorly-reported, this report presents cases for complications of NaOCl accident. Complying to the suggested criteria for well-reported NaOCl accidents, the report aims to help—with others—in clarifying the full picture of the situation Accordingly, a standardized plan for its prevention and management would be possible. Case Description: The current report presents three cases of females with post-NaOCl accident symptoms after performing endodontic treatment for a maxillary anterior tooth. The three patients presented after days of the accident with a deep ulcer in the buccal vestibule related to the treated tooth. Each case suffered from a further different complication in the form of: paresthesia of the infraorbital nerve in the first case, transient partial facial palsy beside the sensory deficit in the second case, and necrosis and deepening of the oral ulcer in the third patient. The cases received roughly the same treatment of oral ulcer debridement and dressing application, followed by antibiotic and analgesic prescription. Vitamin B12 supplements were prescribed in case of neural deficits and warm fomentations were advised in case of extraoral swelling. In all cases, post-operative instructions included strict hygiene of the intraoral lesion and daily repeated saline irrigation. The oral ulcers healed within 8 weeks while the neurological deficits were improving by the fourth month. Conclusions: This report emphasizes on the importance of using packs, complying to strict hygiene and prescribing vitamin B12 supplements in improving and accelerating healing of prolonged post-NaOCl accident symptoms. The report may also help anticipate the prognosis of NaOCl accidents with different severities and presentations. Showing the severity of the complications, the report further highlights on the importance of the accident’s prevention, so that all these sequelae would be avoided.