Navigating an endodontic emergency: A case report on the management of NAOCL extrusion

Abstract

Introduction: Sodium hypochlorite (NaOCl) is the irrigant of choice in endodontic treatment, however, its accidental extrusion into the periapical tissues can cause severe damage. Case Presentation: A 46-year-old female patient, systemically healthy and with no history of allergies, presented to the undergraduate clinic with interproximal caries and resin leakage in tooth #14. Pulp vitality tests elicited a hypersensitive response lasting more than five minutes, leading to a diagnosis of asymptomatic irreversible pulpitis. A biopulpectomy was therefore indicated. Treatment and Accident Management: During the procedure, while irrigating with NaOCl under anesthesia and absolute isolation, the patient reported sudden, intense pain and a burning sensation, followed by almost immediate edema of the soft tissues in the middle third of the face. The treatment was promptly discontinued. Immediate management included the administration of local anesthesia to the affected area for pain control, followed by copious irrigation of the canal with double-distilled water. Intracanal medication (ophthalmic Alin, containing dexamethasone and neomycin) was applied. The patient received an injectable dose of dexamethasone (8 mg) and was kept under observation for one hour to monitor symptom progression. Antibiotic prophylaxis with amoxicillin/clavulanic acid (875 mg/125 mg) and analgesic/anti-inflammatory therapy with ibuprofen (800 mg) were prescribed. Results: The patient's symptoms resolved favorably, and the endodontic treatment was successfully completed fourteen days after the accident. Conclusions: This case underscores the importance of preparedness for potential NaOCl extrusion accidents. Clinicians must be familiar with alternative irrigants to ensure patient safety while achieving satisfactory outcomes. Furthermore, a thorough understanding of the appropriate pharmacological management for such incidents is crucial. Finally, maintaining close and continuous communication with the patient is essential for monitoring symptom evolution and ensuring optimal recovery.