Accidental injection of sodium hypochlorite instead of local anesthetic in a patient scheduled for endodontic procedure

Abstract

We present here a case of tissue destruction and paresthesia following the accidental injection of sodium hypochlorite instead of local anesthetic in a patient scheduled for endodontic procedure. The accident was managed by the local injection of steroid, debridement of necrotic tissue, daily dressings and medications. Wound healing was satisfactory at the end of 1 month. An extra-oral scar and a small area of paresthesia persisted even after 5 years.

Accidents with sodium hypochlorite in Endodontics: A literature review of clinical cases

“…The roots of certain groups of teeth maintain a close relationship with the maxillary sinus, which was decisive to worsen solution overflow in more than one case. 33,35 Paresthesia, whether more or less intense, was also reported 31,33,34,39,40,41,42,45,47 and, in some cases, did not return to normality. Swelling and ecchymosis are also commonly reported, 29,30,31,33,34,36,39,[40][41][42][43][44][45][46][47][48] in addition to episodes of secondary infection.…”

“…33,35 Paresthesia, whether more or less intense, was also reported 31,33,34,39,40,41,42,45,47 and, in some cases, did not return to normality. Swelling and ecchymosis are also commonly reported, 29,30,31,33,34,36,39,[40][41][42][43][44][45][46][47][48] in addition to episodes of secondary infection. 31,33,34,41,43,46,48 Two cases pointed out the occurrence of intracanal hemorrhage, 29,31 while others reported the formation of wound with necrotic tissue, 38,40,42,47 extraoral chemical burn, 37 and open wound with secretion and tissue necrosis.…”

“…NaClO solution overflow occurs through the apical foramen, 29,30,[33][34][35][36]41,43,45,46 by means of perforations, 31,33,40,48 root fracture, 44 incorrect use of irrigation syringes and needles affecting the region of patient's eyes, 32 incomplete isolation of compromised tooth allowing solution overflow through the rubber dam, 37 during cementation of the prosthetic post in the attempt to promote root canal cleaning, 39 as a result of careless exchange of cartridges containing anesthetics for those containing irrigating solution. 38,42,47 It also occurs in teeth subjected to apical surgery 39 and under instrumentation. 34,46 Intense pain occurred in all cases.…”

“…Swelling and ecchymosis are also commonly reported, 29,30,31,33,34,36,39,[40][41][42][43][44][45][46][47][48] in addition to episodes of secondary infection. 31,33,34,41,43,46,48 Two cases pointed out the occurrence of intracanal hemorrhage, 29,31 while others reported the formation of wound with necrotic tissue, 38,40,42,47 extraoral chemical burn, 37 and open wound with secretion and tissue necrosis. 31,34,48 In addition to reports of motor paralysis and facial asymmetry resulting from NaClO overflow, 39 two articles also reported patient's death.…”

“…In 2011, Waknis et al 47 reported complications arising during an anaesthetic procedure carried out in a 33-year-old patient. In that event, the cartridges containing anesthetics were exchanged for those containing 3% NaClO.…”