What to do when you have a sodium hypochlorite accident during a root canal?

Sodium hypochlorite accidents can happen if you do enough root canals. They are fortunately pretty rare. There are things that you can do to diminish the risk but there are some teeth and situations that are more prone to this occurring. Other names for sodium hypochlorite accident are bleach accident or NaOCl accident.

The best tips for a bleach accident are prevention tips.

Using a side-vented needle with the correct pump technique should prevent this from happening in just about any cases. The cases where a sodium hypochlorite accident is more likely is on a tooth with a large apical opening and the apex is out of the bone.

What are the signs of a sodium hypochlorite accident?

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 or shocking sensation to the patient. The patient may also have immediate swelling.

Who is at risk of a bleach extrusion accident?

Low bone density is a risk factor for having NaOCl extrusion so females with root canals in the maxilla are most at risk. Any tooth with a large apical foramen is at risk and anyone with the apex of the tooth in soft tissue or having very thin bone covering is at risk. Another risk factor is teeth with resorbed apex from external or internal resorption. Things a dentist can do wrong is over-enlarge the apical stop and/or go too long.

What should you do once a sodium hypochlorite accident occurs?

Here is the step-by-step protcol of what to do when you have a bleach accident.

1. Aspirate NaOCl out with a needle syringe or whatever the smallest cannula suction tip you have is.
2. Irrigation the canal with copious saline
3. Have the patient take 600mg ibuprofen 3 times a day for 3 days
4. Optional to have the patient take a medrol dose pack. This probably depends on the severity of the case and how much sodium hypochlorite got into the apical tissue.
5. Have the patient take pen VK 500mg 28 tabs qid
6. Cold pack in area for 2 days then heat pack.
7. Finally, and this is probably the most important, is inform the patient and follow up with them repeatedly to ensure healing properly.

What can the patient expect from a sodium hypochlorite accident?

Sodium hypochlorite accident of an upper canine with a large apical foramina that was outside the bone.

Prepare the patient for what could be major edema and bruising on the side of the face with the procedure.  There will be significant swelling and pain.  The first 2-3 days the swelling will spread and pain will increase.  After day 3 those two symptoms will start to decrease and the bruising will become more evident.  Days 4-5 the patient should be looking and feeling better.  After 2 weeks you can expect total resolution. There is a risk for nerve damage, so following up is critical.