Sodium hypochlorite (NaOCl) is one of the most commonly used irrigant because of its several advantages. However, it is highly cytotoxic and can lead to severe tissue damage. NaOCl accident occurs when it is extruded beyond root confines into periapical or periradicular tissues. It is an irrigant mishap which can be life threatening and/or cause residual or long term or permanent consequences with malpractice and medico-legal implications. There are many factors which can influence the occurrence and progress of NaOCl accident. These factors can be broadly categorized as patient (host)-, tooth-, operator-, and NaOCl-related factors. They can be further categorized as predisposing and extent factors. It is vital for a clinician to thoroughly understand and identify various influencing factors to prevent NaOCl accident with its associated consequences including any potential medico-legal issues. The purpose of this article is to provide a narrative review on various factors which predispose to the occurrence of NaOCl accident and influence its extent and/or outcome.
A metallic obstruction in the canal orifice of a maxillary right canine could not be bypassed during endodontic treatment. Aids such as ultrasonics and retrieval kits were not available for the removal of the obstruction. Therefore, a novel approach using a disposable syringe needle was employed. A 22-gauge needle was inserted into the orifice and turned in an arc with a gentle apical pressure and alternate rocking motion around the obstruction. This procedure was repeated few times to cut dentin and successfully dislodge and remove the obstruction using the sharp beveled tip of the needle. This case report demonstrates that, in the absence of other aids, the use of a disposable syringe needle is a simple, economical, and yet an effective technique for conservative removal of dentin and to dislodge and remove an obstruction from the root canal. However, its effectiveness depends on case selection and straight-line accessibility to the obstruction.
Dental erosion has become a major problem that affects the long-term health of the dentition. Among the various potential causes for erosive tooth wear, the different drugs prescribed for patients may be overlooked. Several therapeutic medications can directly or indirectly be associated with dental erosion. It is the responsibility of oral health providers to make both patients and colleagues aware of drugs that may contribute to this condition. Therefore, the purpose of this discussion is to provide an overview of the various therapeutic medications that can be related to tooth erosion. The authors also include precautionary measures-summarized as The 9 Rs-to avoid or at least reduce medication-induced erosion.