Before you reach for the bleach...

The Effect of 8.25% Sodium Hypochlorite on Dental Pulp Dissolution and Dentin Flexural Strength and Modulus

“…There have been multiple case reports on NaOCl incidents that include clinical symptoms of severe pain, edema, bleeding, ecchymosis, and potential for infection (15)(16)(17)(18). As a result, many have cautioned against the use of a concentrated NaOCl solution because of its cytotoxicity and potential for clinical complications if extruded into the periradicular tissues (9,(17)(18)(19).…”

Guidelines for management of sodium hypochlorite extrusion injuries

“…Case reports have noted weakness of muscles associated with the buccal and also marginal mandibular branches of the facial nerve, 27,28 as well as sensory disturbances of mandibular and maxillary branches of the trigeminal nerve. 13 Therefore, a cranial nerve examination should be undertaken with particular emphasis on the trigeminal nerve and facial nerve.…”

“…In the cases of teeth which have been crowned, endodontic access must be carefully assessed as the crown and root angulations may differ. 13 During apical preparation of the root canal system, it is important to shape to the apical constriction. In cases where this has been over prepared, the loss of apical constriction will lead to an increased risk of hypochlorite extrusion.…”

Classification of Nerve Injuries

“…Bleach extravasation beyond the root canal apex into the surrounding tissue can cause a plethora of signs and symptoms ranging from weakness and paresthesia to neuropathic pain and tissue necrosis. The onset of these signs and symptoms can range from immediate onset to late onset [ 23 ] . All root canal sealants are neurotoxic to some degree depending upon the level of penetration of the epineurium.…”

“…Bleach, or sodium hypochlorite, is the most commonly used irrigant in endodontics due to its dual action as a powerful antimicrobial agent and its ability to dissolve organic soft tissue in the root canal system [ 23 ] . Bleach extravasation beyond the root canal apex into the surrounding tissue can cause a plethora of signs and symptoms ranging from weakness and paresthesia to neuropathic pain and tissue necrosis.…”