Authors: Becker GL, Cohen S, Borer R.
Title: The sequelae of accidentally injecting sodium hypochlorite beyond the root apex. Report of a case.
Journal: Oral Surg Oral Med Oral Pathol
Date: Oct 1974
Citation: 38(4):633-8
Category: Irrigants and Medicaments
Evidence-based Ranking: 4
Purpose/ Objectives: A case report that describes the accidental injection of sodium hypochlorite through a root canal into the periapical tissues.

Case report: A 23-year-old white female with deep mesial caries on maxillary right cuspid. On the obturation appointment, a 25-gauge needle was wedged in the canal, and approximately 0.5 c.c. of sodium hypochorite was extruded to the periapical tissue. Within 30 seconds the patient’s right cheek and upper lip showed signs of edema, ecchymosis inferior to the right zygoma, and profuse hemorrhage through the canal. The patient then complained of extreme pain that radiated from the right side of the nose to the parotid gland to the ear. Palliative therapy was immediately instituted with wet and cold compresses applied to the face for the next 25 minutes. Two 4mg tablets of dimetane, two 325mg tablets of Tylenol, and two 250mg tablets of tetracycline were administered. Patient was also prescribed with 24 Dimetane and 30 tetracycline tablets, two of each four times a day. Patient was seen the next day. Her lips were swollen and her right eye was swollen shut, she was advised to change from ice packs to heat packs. One week after the accident the lower eyelid and upper lip had an ecchymotic appearance, but most of swelling had subsided. One month after the accident, the patient’s face had returned to normal.

Author’s Conclusion: To prevent the accidental injection of sodium hypochlorite into the periapical tissues: 1. express the intracanal irrigant slowly, and 2. be sure that the syringe needle is not wedged in the canal.

Reviewer’s Comments: It is useful in reminding practioners to be very cautious not to wedge the needle in the canals when using NaOCl. Also, if accident did happened, render the indicated palliative and protective therapy.