Best treatment, like most, is prevention. Using a side-vented needle with the correct pump technique should prevent this from ever happening.
Signs of extrusion of NaOCl into the periapical tissue and beyond are failure of solution to continue to flow out endo access, intense bleeding, and perhaps a burning sensation to the patient.
- Aspirate NaOCl out
- Irrigation with sterile saline
- 600mg ibuprofen 3 times a day for 3 days (my 3x3x3 rule)
- Medrol dose pack
- Pen VK 500mg 28 tabs qid
- Cold pack in area for 2 days then heat pack
Now prepare the patient for what could be major edema and bruising throughout the entire side of the face that is affected. There will be significant swelling and pain. The first 2-3 days the swelling will spread and pain will increase. After day 3 those 2 symptoms will start to decrease and the bruising will become more evident. Days 4-5 the patient should be looking and feeling better. 2 weeks for total resolution.