Risks and Management of Sodium Hypochlorite in Endodontics

Endodontic emergencies are associated with pain and swelling which requires immediate diagnosis and treatment. The main causative factors for these emergencies are pulp and peri-radicular pathosis, traumatic injuries, procedural complications; were sodium hypochlorite accidents can occur. The impetus behind a successful root canal treatment relies on a thorough debridement of tissue remnants, bacteria and toxins from the root canal system. For a proper clean canal, mechanical preparations alone are insufficient, as reviewed by Haapasalo et al. [1]. Several studies shows that instrumentation alone were not 100 % effective to debride and clean the canals but has to be in conjunction with irrigants [2-6]. Uninstrumented areas were reported in 65% of instrumented oval canals, according to Wu and Wesselink [7]. The morphology of the canals makes it difficult for a complete debridement of root canals, as residual pulp tissue and bacteria may persists in the irregularities of the canal. Therefore, irrigants should support and compliment endodontic preparations by flushing out dentinal debris, dissolving organic tissues, disinfecting the canal and providing lubrication during instrumentation without irritating the surrounding tissues. Hydrogen peroxide, chlorhexidine, saline are some of the irrigants used; among which sodium hypochlorite is the commonly used effective antimicrobial and tissue dissolving irrigant. Concentrations of sodium hypochlorite ranges from 0.5%-5.2%, which is applied to the canals during and after mechanical preparation. Effective concentration range of sodium hypochlorite is from 2.6%5.25% [8, 9].