Sodium Hypochlorite as an Endodontic Irrigant

Anatomy of Sodium Hypochlorite Accidents by Omid Mehdipour, DDS Donald J. Kleier, DMD Robert E. Averbach, DDS

Omid Mehdipour, DDS International Student Program Donald J. Kleier, DMD Professor and Chairman Robert E. Averbach, DDS Professor of Endodontics Division of Endodontics University of Colorado School of Dental Medicine Aurora, Colorado

Abstract Sodium hypochlorite (NaOCl) in various concentrations is the most widely used endodontic irrigant, but it can be an irritant to vital tissues. There are several reports about the complications of irrigation with NaOCl during root canal therapy. Most of the complications are the result of accidental extrusion of the solution from the apical foramen or accessory canals or perforations into the periapical area. This article is a review and comparison of all reported NaOCl accidents in the literature. The impetus behind root canal cleaning and shaping is the elimination of tissue remnants, bacteria, and toxins from the root canal system. This is generally accepted to be a major factor in the success of root canal treatment. Mechanical procedures alone are insufficient for total canal cleaning. Residual pulpal tissue, bacteria, and dentin debris may persist in the irregularities of canal systems. Therefore, irrigating solutions should support and complement endodontic preparation. These irrigants should flush out dentin debris, dissolve organic tissue, disinfect the canal system, and provide lubrication during instrumentation, without irritating the surrounding tissues. Some of the irrigants currently used include hydrogen peroxide, physiologic saline, water, sodium hypochlorite (NaOCl), chlorhexidine, and electrochemically activated water. Because of its physicochemical and antibacterial properties, NaOCl is one of the most popular irrigants. A 0.5% solution of NaOCl was used effectively during World War I to clean contaminated wounds.1 In 1920, Crane described the use of Dakin 's solution (NaOCl buffered with

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