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A patient was brought to A&E by their GDP who had injected sodium hypochlorite (NaOCl) through a perforation in the patient's LR4, resulting in pain, swelling and immediate formation of a large, necrotic ulcer. Within 2 days, the patient developed paraesthesia in the distribution of the right mental nerve. Antibiotics and steroids were prescribed to alleviate the acute symptoms. The perforation was repaired with mineral trioxide aggregate (MTA) and root canal treatment was completed with the aid of a microscope. Review appointments were arranged to monitor healing of the injury.
CPD/Clinical Relevance: Management of iatrogenic root perforation and associated NaOCl injury is useful knowledge.
Article
Sodium hypochlorite (NaOCl) is usually encountered as a dilute solution and has been used as household bleach since the 18th century. It has a pH between 11 and 12. Owing to its bactericidal properties and its ability to dissolve organic matter, it has become the most widely used irrigant in endodontics and is typically found in preparations of between 0.5% and 6% concentration.1,2 However, care must be taken over its safe use because it is highly caustic to the tissues of the human body and related injuries are a well-documented risk. When NaOCl solution is extruded beyond the root canal system, either through the apical foramen or through a root perforation, it causes damage to organic structures and results in an intense inflammatory response. Scarring, deformation of soft tissues and nerve damage can result and these may be permanent.3,4,5,6
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