SODIM HYPOCHLORITE ACCIDENT DURING ENDODONTIC TREATMENT: CAUSES, RISK FACTORS AND PROTOCOL OF MEASURES

Abstract

Purpose of the study. To systematize data regarding main causes of the hypochlorite accidents development, to verify and evaluate potential risk factors associated with the occurrence of clinically significant periradicular extrusion of sodium hypochlorite, and analyze approaches of providing dental and medical care for such type of complication during endodontic treatment. Research methods. Retrospective literature review and content analysis of selected publications, related with the issues of causes, risk factors and approaches for treatment/care of hypochlorite accidents that developed during endodontic treatment, were used as the main research methods. In order to maximize the volume of the initial target publications sample, the search for such publications was carried out within the Google Scholar system (https://scholar.google.com/) using the advanced search capabilities and the following keywords: “hypochlorite accident” and “endodontics”. Scientific novelty. Rather the parameter of high pressure, and not the actual amount of extruded irrigant, is considered to be the key one for the occurrence of a hypochlorite accident, because the volume of sodium hypochlorite that was used for irrigation in cases of accidents in various described clinical cases ranged from 0,1 to 30 ml. According to the results of literature data processing, it was possible to establish that the most frequently cases of hypochlorite accidents were characterized by the development of pain (in all clinical cases), edema (in 38,89 % of clinical cases), edema and ecchymoses (in 38,89 % of clinical cases), and twice as rarely by the development of ulceration (in 16,67 % of clinical cases). The basic principles of providing care for hypochlorite accidents include the following: control of pain, control of edema, and control of complications. Immediate negative aspiration of the solution right after the patient experiences pain due to sodium hypochlorite extrusion into the periradicular space can reduce the risk of severe complications development. Conclusions. Most cases of hypochlorite accidents are iatrogenic by their origin, however, in a number of clinical situations, such can be provoked by anatomical features and conditions of the maxillo-facial region’s structures (presence of fenestrations, root resorption, not completely formed root apex) and their spatial relationship with each other. The occurrence of a hypochlorite accident is associated with the development of a specific complex of symptoms, which in the majority of clinical cases includes pain, swelling, appearance of ecchymoses, and less often necrosis of soft tissues, ulcers, neurological deficits and trismus of the masticatory muscles take place. In the case of the mild and moderate hypochlorite accidents development the approach of taking care for this complication is conservative, while severe hypochlorite accidents require the patient to be referred to the department of maxillofacial surgery or intensive therapy.