Sodium hypochlorite accident diagnosis and management: Analysis from the literature and the French pharmacovigilance database

IF 2.1 4区 医学 Q3 PHARMACOLOGY & PHARMACY Fundamental & Clinical Pharmacology Pub Date : 2024-01-24 DOI:10.1111/fcp.12985
Zahoua Kartit, Céline Delacroix, Céline Clement, Mathilde Beurrier, Claudie Mouton-Faivre, Nadine Petitpain
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Abstract

Purpose

Sodium hypochlorite (NaOCl) is considered as the reference irrigation solution in endodontics. However, NaOCl-related accidents may occur, and non-dentist health professionals might under-recognize this rare adverse effect although it is potentially severe, with possible medical and aesthetic sequelae. We performed a literature review to provide to non-dentist healthcare professionals a large picture of symptoms, management and potential consequences of NaOCl accidents.

Methods

We queried PubMed and the French Pharmacovigilance database and retrieved 76 cases for analysis (70 from 57 published articles, and six from the database).

Results

The analysis showed that patients were mostly women (79%), aged around of 42 years, undergoing upper jawbone (74%) endodontic procedure. NaOCl concentration ranged from 1% to 10%, with 0.5 to 30 mL injected. Most cases (86%) corresponded to an accidental extrusion beyond the root apex to the periapical tissues, followed by tissular injection by error (8%) and extrusion into the maxillary sinus (3%). Local symptoms always occurred within 24 h, mostly pain (99%), edema (89%) and/or ecchymosis (61%). Complications were mainly neurological (29%), necrotic (22%) and cutaneous (9%). Most of patients (76%) fully recovered after medical management but 18 (24%) required surgical management.

Conclusion

Any healthcare professional should be aware of the classical symptomatic triad of NaOCl accident with sudden pain, haemorrhage/ecchymosis and swelling, to start or recommend adequate management. Patients should be reassured, but a close follow-up is necessary to avoid delayed complication.

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次氯酸钠事故的诊断和处理:文献和法国药物警戒数据库分析。
目的:次氯酸钠(NaOCl)被认为是牙髓病学的参考灌洗溶液。然而,与次氯酸钠相关的事故可能会发生,非牙科医生保健专业人员可能对这种罕见的不良反应认识不足,尽管这种不良反应可能很严重,并可能带来医疗和美学后遗症。我们进行了一次文献综述,旨在为非牙科医生的医疗保健专业人员提供有关 NaOCl 事故的症状、处理方法和潜在后果的全面信息:我们查询了 PubMed 和法国药物警戒数据库,并检索了 76 个病例进行分析(其中 70 例来自 57 篇发表的文章,6 例来自数据库):分析结果显示,患者多为女性(79%),年龄在 42 岁左右,正在接受上颌骨牙髓治疗(74%)。NaOCl 浓度从 1%到 10%不等,注射量从 0.5 毫升到 30 毫升不等。大多数病例(86%)是由于意外挤出根尖至根尖周围组织,其次是组织注射错误(8%)和挤入上颌窦(3%)。局部症状总是在 24 小时内出现,主要是疼痛(99%)、水肿(89%)和/或瘀斑(61%)。并发症主要是神经系统(29%)、坏死(22%)和皮肤(9%)。大多数患者(76%)在接受内科治疗后完全康复,但有18名患者(24%)需要接受外科治疗:任何医护人员都应了解 NaOCl 事故的典型症状三联征,即突然疼痛、出血/瘀斑和肿胀,以便开始或建议适当的治疗。患者应得到安抚,但有必要进行密切随访,以避免延误并发症的发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
6.90%
发文量
111
审稿时长
6-12 weeks
期刊介绍: Fundamental & Clinical Pharmacology publishes reports describing important and novel developments in fundamental as well as clinical research relevant to drug therapy. Original articles, short communications and reviews are published on all aspects of experimental and clinical pharmacology including: Antimicrobial, Antiviral Agents Autonomic Pharmacology Cardiovascular Pharmacology Cellular Pharmacology Clinical Trials Endocrinopharmacology Gene Therapy Inflammation, Immunopharmacology Lipids, Atherosclerosis Liver and G-I Tract Pharmacology Metabolism, Pharmacokinetics Neuropharmacology Neuropsychopharmacology Oncopharmacology Pediatric Pharmacology Development Pharmacoeconomics Pharmacoepidemiology Pharmacogenetics, Pharmacogenomics Pharmacovigilance Pulmonary Pharmacology Receptors, Signal Transduction Renal Pharmacology Thrombosis and Hemostasis Toxicopharmacology Clinical research, including clinical studies and clinical trials, may cover disciplines such as pharmacokinetics, pharmacodynamics, pharmacovigilance, pharmacoepidemiology, pharmacogenomics and pharmacoeconomics. Basic research articles from fields such as physiology and molecular biology which contribute to an understanding of drug therapy are also welcomed.
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