sodium hypochlorite
Regulatory sources consulted
Approved indications
- Prevention and treatment of skin and tissue infections, including pre- and postoperative wounds, cuts, abrasions, and skin ulcers.
Contraindications
Absolute
- Sensitivity to chlorine compounds.
Clinical warnings
- For external use only. — FDA/openFDA, SPL set_id 3d72b72c-2949-4eb6-b64c-6c4aef0eddd9
- Stop use and seek advice if redness, irritation, swelling, or pain persists or increases. — FDA/openFDA, SPL set_id 3d72b72c-2949-4eb6-b64c-6c4aef0eddd9
- Major warning · Keep out of reach of children. If swallowed, get medical help or contact a Poison Control Center immediately. — FDA/openFDA, SPL set_id 3d72b72c-2949-4eb6-b64c-6c4aef0eddd9
Pregnancy and lactation
No specific pregnancy or breastfeeding recommendation is available.
Recent literature (PubMed)
Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long-term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long-term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system.
Irrigation of root canal system is of great significance to the success of endodontic treatment, where sodium hypochlorite (NaOCl) is the most widely used irrigant in chemical preparation. NaOCl functions by eliminating bacterial biofilms and dissolving organic tissue, which may vary according to several factors such as the microbiology of root canal infection and the concentration of the irrigant. It has been proposed that the effectiveness of NaOCl could be enhanced via several methods, including heating the irrigant, applying in conjunction with certain reagents, or activating by agitation techniques. Despite its antibacterial and tissue-dissolving capacities, NaOCl should be used with caution to avoid detrimental effect due to its cytotoxicity and negative effect on dentin properties. In this narrative review, we discussed the factors that affect the properties of NaOCl, the methods to improve its efficacy, and the side effects that might occur in clinical practice.
Sodium hypochlorite (NaOCl) is widely utilized in endodontics for its effective antimicrobial properties and ability to dissolve necrotic tissues. However, its use is not devoid of risks, including potential severe tissue damage and chemical burns. This systematic review evaluates the documented risks of using NaOCl in endodontic treatments. It compares its safety and efficacy with other endodontic irrigants, such as EDTA and chlorhexidine. This review followed the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines and registered with PROSPERO. Comprehensive searches were performed in PubMed, Scopus, Web of Science, and CENTRAL databases, with additional hand searches in grey literature. Studies were selected reporting adverse effects related to NaOCl used in endodontic procedures, ranging from randomized controlled trials to case reports. Data extraction and risk of bias assessment were systematically performed using standardized tools. Seventeen studies were included, detailing instances from chemical burns to severe allergic reactions and tissue necrosis associated with NaOCl use. The risk of bias was predominantly low across the studies. Sodium hypochlorite demonstrated a higher efficacy in microbial eradication and tissue dissolution than other irrigants, though it also showed a higher incidence of severe complications when mishandled. Sodium hypochlorite remains a cornerstone in endodontic disinfection due to its potent antimicrobial and tissue dissolution properties. However, its application must be meticulously managed to prevent complications. Future research should focus on optimizing concentrations and application techniques to enhance safety and effectiveness, potentially integrating safer alternatives or complementary solutions like EDTA to mitigate risks while preserving irrigant benefits.
Issues arising in wound healing are very common, and chronic wound infections affect approximately 1.5% of the population. The main substances used in wound washing, cleansing and treatment are antiseptics. Today, there are many compounds with a known antiseptic activity. Older antiseptics (e.g., boric acid, ethacridine lactate, potassium permanganate, hydrogen peroxide, iodoform, iodine and dyes) are not recommended for wound treatment due to a number of disadvantages. According to the newest guidelines of the Polish Society for Wound Treatment and the German Consensus on Wound Antisepsis, only the following antiseptics should be taken into account for wound treatment: octenidine (OCT), polihexanide (PHMB), povidone-iodine (PVP-I), sodium hypochlorite (NaOCl) and nanosilver. This article provides an overview of the five antiseptics mentioned above, their chemical properties, wound applications, side effects and safety.
Sodium hypochlorite (NaOCl) solution is a widely used irrigant in endodontics. However, it is highly cytotoxic and can have destructive effects on surrounding tissues when it is not confined to the root canal during irrigation. The extrusion of NaOCl beyond the confines of the root canal into the surrounding tissues or anatomical spaces is known as a NaOCl accident. The NaOCl accident is a serious iatrogenic mishap that can lead to severe tissue damage and complications, which can be life-threatening and/or cause long-term or permanent consequences with medico-legal implications. Therefore, this narrative review was conducted to provide clinicians with a comprehensive understanding of the mechanism and clinical aspects of NaOCl accidents. A literature search was conducted in various online databases using specific Medical Subject Headings (MeSH) and key search terms. The review included all categories of articles dealing with the NaOCl accident and available as full text. Additionally, a manual method of search was conducted by screening references of the included articles. Duplicate articles and articles available only as abstracts were excluded from the review. The included articles were reviewed, analyzed and discussed according to the following sections: causative factors; mechanism; clinical categorization; clinical manifestations; diagnosis, including history, clinical assessment and examination, clinical investigation, and differential diagnoses; and treatment planning of NaOCl accidents. This would enable clinicians to recognize and manage NaOCl accidents in the best possible manner and minimize their serious consequences. Future research should prioritize the identification of solutions or measures to address the challenges associated with conducting clinical or in vivo studies on NaOCl irrigation and extrusion.