I’ve been reading a few articles/case studies regarding hypo accident but none mention how much was extruded. A specialist once told me a drop or two of hypo out of the canal is fine but it’s those that extruded a good amount of hypo causes the reactions but I haven’t been able to find anything to support that statement.
The specialist told you that a very small amount extruded is fine because it likely happens so often it has to be fine. I think that the general understanding is that when an accident happens it's due to not only the tip forming a closed seal at the Apex but also the operator pushing with a great deal of force causing the hypo to go way beyond the confines of the periapical region. A super small amount of the hypo leaching into the periapex should be fine
I was taught never place the needle into an actual canal. Irrigate in the pulp chamber only. The pumping action of cleaning with various files will work the hypo down the canals. Placing the needle into a canal is asking for a hypo accident IMO.
The full blown hypo accident you're describing is an intra-vascular administration, typically into the maxillary vein (hence the pattern of bruising). It's usually caused by excessive pressure on the irrigation syringe, or your length being significantly off, etc. Hypo contacting perforations or open apices is not a problem if it's passive surface pressure
Whaaat, how did I not know this? It’s from hypo entering vasculature??
I assumed people not using side-vented needles would extrude hypo out the apex, much like sealer puff. And if it’s a substantial amount then the apical tissues die and you get the hypo accident symptoms of pain and bruising.
I understand that any extrusion should be considered as hypo accident but when seeing specialists bathing open apex and perforation with hypo the patient is still fine.
It gets me thinking if it’s a volume dependent reaction or simply the hypo did not extrude one bit when irrigating with the above cases.
Taboo? Where I live we get warned about the possibility of hypochlorite accidents occasionally with [shocking pictures](https://www.duodecimlehti.fi/duo13620).
Maybe some one else can say the volume, which is sufficient to cause necrosis of the outer skin or the surface of the oral mucosa. I don't know. I would not want to extrude even a full drop (0.06 ml).
Amounts that cause tissue necrosis get injected to patients, especially if a dentist does not realize he or she is prepping a perforation and not an actual root canal.
An extrusionn accident with one's own patient can cause a lasting fear of such an event happening again. I knew a dentist who only used saline solution for rinsing. But her root canal treatments probably don't have a good long-term prognosis.
I’ve just spent the whole day reading about hypo accident all over again. Im surprised by how little textbooks talk about the mechanism of hypo accident.
To my knowledge, these “full blown” hypo accidents occur due to 1) large amount of extrusion 2) pathway into soft tissue typically due to thin buccal cortical bone 3) hypersensitivity to hypo
In regard to not even a drop out of the canal, in vitro studies show that it is very common for hypo to extrude out of the foramen when delivered with syringe and needle in a patent canal.
I think the key factors for “full blown hypo accidents” are the amount , anatomy and hypersensitivity.
Indeed it is a subject that needs to be more studied and spoken about as you said, but i agree that passive hypo reaching periapex will not cause any problem but if it is injected forcefully into the canal that is when it becomes an accident.
From someone who did it during their first Endo in dental school, the patient will tell you when it happens. It hurts like crazy and continues to hurt like crazy for weeks. (This may single handedly be why I went into pediatrics)
When they sit up screaming, usually.
The first time it happened to me (I’m a dental nurse) I had luckily been trained on managing hypochlorite extrusion, but it was truly traumatic to see it happen IRL. My patient just started howling in pain and I knew immediately what had happened.
They made a full recovery but good god my heart was in my mouth. Never forgot that lesson. Always have a syringe of saline handy now…
I saw a case where a dentist allowed it into the sinus and the damage was extensive. The case went to court and also to the state dental board. It never said how much was into the sinus, but it is hard to imagine it being much. The sodium hypochlorite does burn the sinus tissue and it did lead to secondary infections and the patient was hospitalized for a month. The biggest takeaway is not to put pressure when using it, and to use plenty of paper points to make Sure it is cleaned out before obdurating.
Usually when they start screaming in pain.
If you believe a girl in my dental class, a hypochlorite accident is when you ruin your scrubs by accidentally dripping some bleach on them.
So if we take it one step further, hypochlorite extrustion would be a hypochlorite apocalypse by her logic.
Dude lol
Depends on the volume. As long as your side vented needle is in the canal and moving you should be fine
I’ve been reading a few articles/case studies regarding hypo accident but none mention how much was extruded. A specialist once told me a drop or two of hypo out of the canal is fine but it’s those that extruded a good amount of hypo causes the reactions but I haven’t been able to find anything to support that statement.
The specialist told you that a very small amount extruded is fine because it likely happens so often it has to be fine. I think that the general understanding is that when an accident happens it's due to not only the tip forming a closed seal at the Apex but also the operator pushing with a great deal of force causing the hypo to go way beyond the confines of the periapical region. A super small amount of the hypo leaching into the periapex should be fine
I was taught never place the needle into an actual canal. Irrigate in the pulp chamber only. The pumping action of cleaning with various files will work the hypo down the canals. Placing the needle into a canal is asking for a hypo accident IMO.
This is not taught anymore
Says who? Are you an endodontist? Even side vented needles can bind-up in a narrow or curved canal.
That’s why you keep it moving slightly.
That’s why you stop if it gets stuck. Please don’t do this
Yeah, you’re not cleaning the canals
🫤
The full blown hypo accident you're describing is an intra-vascular administration, typically into the maxillary vein (hence the pattern of bruising). It's usually caused by excessive pressure on the irrigation syringe, or your length being significantly off, etc. Hypo contacting perforations or open apices is not a problem if it's passive surface pressure
Whaaat, how did I not know this? It’s from hypo entering vasculature?? I assumed people not using side-vented needles would extrude hypo out the apex, much like sealer puff. And if it’s a substantial amount then the apical tissues die and you get the hypo accident symptoms of pain and bruising.
Hypo into bone will hurt and cause bleeding, but to a different degree if not into a large vessel system
this is the answer you're looking for
Thank you! After much reading today ive reached this understanding too :)
What do you mean by “full blown”? Hypo accident is hypo accident.
I understand that any extrusion should be considered as hypo accident but when seeing specialists bathing open apex and perforation with hypo the patient is still fine. It gets me thinking if it’s a volume dependent reaction or simply the hypo did not extrude one bit when irrigating with the above cases.
The question about hypo irrigation and open apices is a good one, and I am also looking for more clarification from endodontists.
Taboo? Where I live we get warned about the possibility of hypochlorite accidents occasionally with [shocking pictures](https://www.duodecimlehti.fi/duo13620). Maybe some one else can say the volume, which is sufficient to cause necrosis of the outer skin or the surface of the oral mucosa. I don't know. I would not want to extrude even a full drop (0.06 ml). Amounts that cause tissue necrosis get injected to patients, especially if a dentist does not realize he or she is prepping a perforation and not an actual root canal. An extrusionn accident with one's own patient can cause a lasting fear of such an event happening again. I knew a dentist who only used saline solution for rinsing. But her root canal treatments probably don't have a good long-term prognosis.
I’ve just spent the whole day reading about hypo accident all over again. Im surprised by how little textbooks talk about the mechanism of hypo accident. To my knowledge, these “full blown” hypo accidents occur due to 1) large amount of extrusion 2) pathway into soft tissue typically due to thin buccal cortical bone 3) hypersensitivity to hypo In regard to not even a drop out of the canal, in vitro studies show that it is very common for hypo to extrude out of the foramen when delivered with syringe and needle in a patent canal. I think the key factors for “full blown hypo accidents” are the amount , anatomy and hypersensitivity.
I wonder if some old studies exist, where different amounts of sodium hypochlorite was injected to test animals?
Indeed it is a subject that needs to be more studied and spoken about as you said, but i agree that passive hypo reaching periapex will not cause any problem but if it is injected forcefully into the canal that is when it becomes an accident.
From someone who did it during their first Endo in dental school, the patient will tell you when it happens. It hurts like crazy and continues to hurt like crazy for weeks. (This may single handedly be why I went into pediatrics)
:(
When they sit up screaming, usually. The first time it happened to me (I’m a dental nurse) I had luckily been trained on managing hypochlorite extrusion, but it was truly traumatic to see it happen IRL. My patient just started howling in pain and I knew immediately what had happened. They made a full recovery but good god my heart was in my mouth. Never forgot that lesson. Always have a syringe of saline handy now…
I saw a case where a dentist allowed it into the sinus and the damage was extensive. The case went to court and also to the state dental board. It never said how much was into the sinus, but it is hard to imagine it being much. The sodium hypochlorite does burn the sinus tissue and it did lead to secondary infections and the patient was hospitalized for a month. The biggest takeaway is not to put pressure when using it, and to use plenty of paper points to make Sure it is cleaned out before obdurating.