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Apex Locators in the diagnosis of perforations

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Hypochlorite accident - Courtesy ROOTS

From: Steve To: ROOTS Sent: Friday, October 20, 2006 4:31 AM Subject: Re: [roots] Hypochlorite Accident Hi all, What is the protocol for dealing with a hypochlorite accident? - Steve The best way is to prevent one, here is part of an old ROOTS thread (2001) and Bill Watson’s recommendations : ( ) I will look up an article for you on NAOCL2 accident and send it - Benjamin Schien From: Jeevan Kumar Santiago To: ROOTS Sent: Tuesday, July 03, 2001 1:25 PM Subject: [roots] the hypochlorite question Though I use lot of hypochlorite ...hmmm... i am pretty scared about the product . I wonder how come this product used for washing clothes landed up washing the inside of people's teeth ! Do you rooters use any standard protocol while using this dangerous / hazardous product ? I have witnessed a hypochloride incident in my friend's office .. BOOOO.. it was scary .. the patient's face was all swollen up and it resembled something like cellulitis ! He was giving predisolone to control the acute inflammation and he was even expecting larngospasm ! Is it a must that we have to continue using this product or is there any alternative available ? Jeevan, We are taught to suction the canal and flush with copious saline, Incise and drain if immediate diffuse swelling, calm the patient, reanesthetize, give amoxicillin 500mg q6h for 7 days, 4 mg Decadron injected in the vestibule near the tooth being worked on, 600 mg Ibuprofen q6h and finally narcotic pain meds of your choice. Follow the patient closely and let them know the pain and swelling will subside in 2-3 days, but bruising could be present for 2-3 weeks. I am sure others will chime in here and I am interested to hear their opinions as well. I have not had an accident(knock on wood) yet, but was covering the clinic when a student had one,Hope this helps - Josh Article - courtesy Benjamin Schien Hülsmann M, Hahn W. Complications during root canal irrigation literature review and case reports. International Endodontic Journal, 33, 186193, 2000. Literature review and case reports The literature concerning the aetiology, symptomatology and therapy of complications during root canal irrigation is reviewed. Three cases of inadvertent injection of sodium hypochlorite and hydrogen peroxide beyond the root apex are presented. Clinical symptoms are discussed, as well as preventive and therapeutic considerations. Symptomatology and therapy after inadvertent injection of NaOCl into the periapical tissues Symptomatology Immediate severe pain Immediate oedema of neighbouring soft tissues Possible extension of oedema over the injured half side of the face, upper lip, infraorbital region Profuse bleeding from the root canal Profuse interstitial bleeding with haemorrhage of the skin and mucosa (ecchymosis) Chlorine taste and irritation of the throat after injection into the maxillary sinus Secondary infection possible Reversible anaesthesia or paraesthesia possible Therapy Patient information on cause and severity of complication Pain control: local anaesthesia, analgesics In severe cases: referral to a hospital Extraoral cold compresses for reduction of swelling After 1 day: warm compresses and frequent warm mouthrinses for stimulation of local systemic circulation Daily recall for control of recovery Antibiotics: not obligatory. Only in cases of high risk or evidence of secondary infection Antihistamine: not obligatory Corticosteroids: controversial Further endodontic therapy with sterile saline or chlorhexidine as root canal irrigants Right on Ben...In my haste to respond, I left out the need for the cold followed by warm compresses.Thanks, Josh I remember a very nasty hypochlorite accident pic presented once on Roots.... Plz. a repost by someone would serve as a good reminder to be extremely careful - Sachin

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