Acidentes com hipoclorito de sódio no tratamento endodôntico: uma revisão de literatura acerca da etiologia e conduta clínica

Abstract

Among the main requirements to achieve success during endodontic treatment are the reduction or elimination of microorganisms from the root canals achieved by mechanical, chemical, and physical action, involving endodontic files, chemical substances, irrigation, and aspiration. Among the chemical substances, Sodium hypochlorite (NaOCl) is one of the main irrigating solutions in the preparation of the root canal system (RCS), due to its action of dissolution organic matter and its antimicrobial activity. However, during irrigation, it needs care by the dentist, due to cytotoxicity when in contact with vital tissues. Therefore, this literature review aims to describe the possible etiologies and clinical conduct related to accidents with sodium hypochlorite during endodontic treatment. For this, studies published on the same topic were searched and indexed in the following databases: Biblioteca Virtual em Saúde (BVS), Scientific Electronic Library Online (Scielo), National Library of Medicine, National Institutes of Health (Pubmed), and Academic Google, using the following keywords: “Sodium Hypochlorite”, “Accidents” and “Root Canal Irrigants”. The accidents with Sodium Hypochlorite are iatrogenic events arising from anatomical factors or professional knowledge and experience, presenting as factors involved: the presence of open apexes and root resorption, the lack of knowledge of internal morphology, poor analysis of the initial radiograph, the determination of Incorrect Actual Working Length (AWL), excessive pressure during irrigation, and failure to use absolute isolation and goggles on the patient. Faced with incidents, it is recommended to immediately interrupt the procedure, giving priority to pain relief, edema control, and prevention of secondary infections. The knowledge of possible accidents with the use of NaOCl and the application of the best conduct in each situation can guarantee a good prognosis, therefore, professionals and undergraduates must be able to act in a preventive way against complications and intervene when necessary.