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PurposeSodium 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.MethodsWe queried PubMed and the French Pharmacovigilance database and retrieved 76 cases for analysis (70 from 57 published articles, and six from the database).ResultsThe 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.ConclusionAny 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.
PurposeSodium 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.MethodsWe queried PubMed and the French Pharmacovigilance database and retrieved 76 cases for analysis (70 from 57 published articles, and six from the database).ResultsThe 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.ConclusionAny 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.
AimThis meta‐analysis aimed to compare the antibacterial efficacy of chitosan/chitosan nanoparticles (Ch/Ch‐NPs) versus sodium hypochlorite/chlorhexidine (NaOCl/CHX).Materials and MethodsA search was performed in four electronic databases until December 08, 2023. Studies with missing, unclear, and insufficient data sets were excluded. The included studies were assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Checklist for Quasi‐Experimental Studies. The meta‐analysis of standardized mean difference was performed using a random effects model. Additionally, funnel plots as well as Egger's regression intercept test were used to evaluate potential publication bias.ResultsA total of 426 samples were used in nine included studies. There was no difference in antibacterial efficacy between Ch/Ch‐NPs‐NaOCl (SMD: 0.005; 95% CI: −0.844–0.854; p = 0.990). However, the antibacterial efficacy of NaOCl was statistically more effective than Ch/Ch‐NPs (SMD: 0.807; 95% CI: 0.015–1.599; p = 0.046) using the bacterial culture method, and Ch/Ch‐NPs was statistically higher than NaOCl (SMD: −1.827; 95% CI: −2.720, −0.934; p < 0.000) using confocal laser scanning microscopy.ConclusionsCh/Ch‐NPs may be an alternative to NaOCl against Enterococcus faecalis. The methods used in the in vitro studies evaluating the antibacterial efficacy of irrigation solutions against E. faecalis may have had an impact on the results.
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