Abstract
The use of sodium hypochlorite (NaOCl) as irrigation solution in endodontics is widespread and accidents of apical extravasation may occur, being in most cases mild to moderate situations of simple management. However, in immunosuppressed patients, the reaction may be exacerbated, with significant systemic changes and potentially life-threatening. Even so, there is a lack of information about the management of these special cases, especially in oncopediatric cases. Therefore, the aim is to report a case of severe reaction post-accident with NaOCl in a 13-year-old adolescent undergoing chemotherapy, with significant edema, gingival necrosis, cutaneous rash, edema of the extremities, pleural effusion, and bronchopneumonia, with a 30-day evolution. It is understood that several factors, including anatomical, may predispose this situation, which can occur even with expert and experienced professionals, not necessarily associated with poor practice. The authors raise the importance of further studies to discuss the real need and indication of the use of NaOCl as an irrigating solution for these patients and suggest the adoption of extra safety measures to avoid the occurrence of similar situations.
Highlights
Sodium hypochlorite (NaOCl) solutions are widely used as antibacterial agents
Given the extremely high risk of a bad outcome from an accident with NaOCl, especially in this population, our objective is to report a case on the adopted management should promote the discussion on how to care for these patients and perhaps consider the solution as a possible contraindication for pediatric patients with cancer
Successful endodontic treatment depends on shaping and cleaning the dental canals, and NaoCl solution is an important adjuvant (Baumgartner et al, 1992). This solution is toxic outside the dental canal (Swanljung et al, 2018), causing inflammatory reactions in the soft tissues, which manifests as pain and localized or diffuse edema (Serpe et al, 2004)
Summary
Sodium hypochlorite (NaOCl) solutions are widely used as antibacterial agents. The available guidelines (Farook et al, 2014; Bosch-Aranda et al, 2012; Kanagasingam et al, 2020) do not include cancer patients, especially pediatric ones, who may, due to severe immunosuppression, have disproportionate and unusual reactions. Our report of a case of life-threatening apical NaOCl extravasation in a pediatric cancer patient should serve as a warning to our colleagues about potential complications. Given the extremely high risk of a bad outcome from an accident with NaOCl, especially in this population, our objective is to report a case on the adopted management should promote the discussion on how to care for these patients and perhaps consider the solution as a possible contraindication for pediatric patients with cancer
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