Complications during root canal treatment

Outlines

Spillage on clothing Accidental spillage on eye Sodium hypochlorite accident Allergic reaction Air emphysema

Spillage on clothing

Accidental spillage on eye

Irrigant contact with the eye result in: Immediate pain Profuse tears Burning sensation Erythema

Management: Immediate ocular irrigation with large amount of water or

sterile saline should be performed by the dentist or the patient.

Patient is referred for ophthalmologist for further examination and treatment

Sodium hypochlorite accident

Causes: Teeth with wide apical foramina Apical constriction destroyed during excessive root canal

preparation Extreme pressure during irrigation Binding of irrigation needle tip in the root canal Not determining working length or going beyond it.

Symptoms Immediate sever pain Immediate edema of the neighboring soft tissue Profuse bleeding from root canal Ecchymosis of the skin and mucosa Chlorine taste in the mouth Irritation of throat if injected in maxillary sinus Possible secondary infection Anesthesia or paresthesia that is reversible Edema may extend to the half side of the face, upper lip and

infraorbital region

management

Inform the patient about the cause and severity of complications Stay calm and reassure the patient Pain control: local anesthetic, analgesics Swelling and edema: extraoral cold compression. After 1 day

replace with warm compression and warm mouthrinse Secondary infection: antibiotics Antihistamine and corticosteroids endodontic treatment can be resumed after the symptom has

resolved, use non-irritant irrigant like CHx and Saline.

Allergic reaction

NaOCl allergies are rare If occurred, refer to hospital. Use non-allergic irrigant instead When the patient is allergic to sodium hypochlorite, he

also considered allergic to CHx.

Air emphysema

Cause When root canal dried with compressed air, which pass

through root canal into periapical area Management

Does not require antibiotic or any other therapy. In most cases resolve after few days.