Soft Tissue Toxicity and Injury from Root Canal Bleach

Use of sodium hypochlorite, or NaOCl, as a chemical adjunct to mechanical debridement of pulp canals is a common practice in endodontics. The solution’s solvent activity for its antibacterial and lubricating properties make it an attractive choice for intra-canal irrigation in endodontic practice. However, if used incorrectly by the dentist, NaOCl can be extremely toxic and destructive to cellular tissues. It is essential that the dentist exhibits respect for the tissues beyond the tooth apex to minimize complications such as - excruciating pain, hematoma, ecchymosis, immediate gross swelling, profuse hemorrhage and connective tissue destruction. Special attention should be given to teeth with wide apexes, resorbtion and apical perforations. Dentists should avoid over instrumentation beyond the tooth apex and wedging the irrigating needle into the root canal. Failure to adhere to careful technique can cause the patient to seek emergency room care, hospitalization with difficult soft tissue management and in worse cases, surgical intervention.