موضوعنا اليوم تكملة لموضوع الأخطاء الطبية
( mishaps or procedural errors )
حوادث هيبوكلورايت الصوديوم
(sodium hypochlorite accidents)
أسبابه، علاماته، علاجه و الوقاية منه.
( mishaps or procedural errors )
حوادث هيبوكلورايت الصوديوم
(sodium hypochlorite accidents)
أسبابه، علاماته، علاجه و الوقاية منه.
Why we are using NaOCL In Endodontics Tx?
an effective irrigating solution in concentrations ranging from 0.5% to 6% and is able to:
-Disrupt the biofilm dissolve necrotic tissues.
-Remove organic components of the smear layer.
However, it is extremely cytotoxic.
an effective irrigating solution in concentrations ranging from 0.5% to 6% and is able to:
-Disrupt the biofilm dissolve necrotic tissues.
-Remove organic components of the smear layer.
However, it is extremely cytotoxic.
Causes of this accident:
1)An inaccurate working length.
2)Iatrogenic widening of the radicular foramen.
3)Lateral perforation of the root.
4)Wedging of the irrigation needle.
1)An inaccurate working length.
2)Iatrogenic widening of the radicular foramen.
3)Lateral perforation of the root.
4)Wedging of the irrigation needle.
Clinical features:
-Severe and immediate pain.
-Edema or bruising that may continue to extend over the injured side of the face, cheek, or lips.
-Hemorrhaging from the canal space.
-In the case of maxillary posterior teeth, the Patient may report periorbital pain.
-Severe and immediate pain.
-Edema or bruising that may continue to extend over the injured side of the face, cheek, or lips.
-Hemorrhaging from the canal space.
-In the case of maxillary posterior teeth, the Patient may report periorbital pain.
-Chlorine taste, or irritation of the throat
-Paresthesia, either transient or permanent, can occur, especially if interventional is not rendered immediately.
In addition to sensory deprivation, motor nerve dysfunction secondary to irreversible chemical damage has been reported
-Paresthesia, either transient or permanent, can occur, especially if interventional is not rendered immediately.
In addition to sensory deprivation, motor nerve dysfunction secondary to irreversible chemical damage has been reported
Managment of NaOCL extrusions:
1)Clinician must cease further treatment.
2)Local anesthetics.
3)Diluting the effect of the extrusion, immediately irrigate the canal with normal saline to encourage bleeding, both diluting the irritant and removing it from the site of the injury.
1)Clinician must cease further treatment.
2)Local anesthetics.
3)Diluting the effect of the extrusion, immediately irrigate the canal with normal saline to encourage bleeding, both diluting the irritant and removing it from the site of the injury.
4)cold compresses, in an effort to moderate swelling and edema.
5)After one day, warm compresses are substituted for the cold, and warm oral rinses are prescribed to stimulate the local microcirculation.
6)Analgesics ( paracetamol + NSAIDs ) very effective in pain control.
5)After one day, warm compresses are substituted for the cold, and warm oral rinses are prescribed to stimulate the local microcirculation.
6)Analgesics ( paracetamol + NSAIDs ) very effective in pain control.
7) Steroid may be used to minimize edema.
Antibiotics might be needed to prevent secondary infection. In more serious cases, referral to a medical center or furthermore surgical intervention may be necessary.
8)The patient should be monitored
closely; Lastly, reassuring patients
Antibiotics might be needed to prevent secondary infection. In more serious cases, referral to a medical center or furthermore surgical intervention may be necessary.
8)The patient should be monitored
closely; Lastly, reassuring patients
Prevention, the clinician should do the following:
◆ Establish an accurate working length and avoid overinstrumentation.
◆ If irrigating using positive pressure, employ a small side vented needle placed no closer than 2 mm from the working length. Express the fluid slowly.
◆ Establish an accurate working length and avoid overinstrumentation.
◆ If irrigating using positive pressure, employ a small side vented needle placed no closer than 2 mm from the working length. Express the fluid slowly.
◆ Carefully assess the canal integrity for signs of perforation or other large portals of fluid egress.
◆ Avoid wedging the needle tip in the canal space or inserting
it beyond the working length.
◆ Confirm the identity of the solution prior to injection or irrigation.
◆ Avoid wedging the needle tip in the canal space or inserting
it beyond the working length.
◆ Confirm the identity of the solution prior to injection or irrigation.
Healing & Prognosis:
It generally took a few weeks,
the shortest healing time was for a cases that had involved the sinus; the tooth and surrounding tissues were asymptomatic with normal contours and color only 4 days after the NaOCl extrusion.
It generally took a few weeks,
the shortest healing time was for a cases that had involved the sinus; the tooth and surrounding tissues were asymptomatic with normal contours and color only 4 days after the NaOCl extrusion.
However, the pain and swelling could last up to 30 days and possibly longer; 1 report documented that it took up to 4 months for the swelling to resolve. Mucosal healing could take up to 60 days.
initially nerve damage and motor impairment can return to normal function at 1 yr.
initially nerve damage and motor impairment can return to normal function at 1 yr.
References:
Cohen S, 11ed, Chapter 19
Guivarc’h et al, JOE, 2017
Cohen S, 11ed, Chapter 19
Guivarc’h et al, JOE, 2017
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