This short presentation discuss very important subject in endodontic field, which is the complications that most commonly occur during root canal treatment, like sodium hypochlorite accident and air emphysema and others. management of these complications is also discussed.

1. Complications during root canal
treatment

2. Outlines
 Spillage on clothing
 Accidental spillage on eye
 Sodium hypochlorite accident
 Allergic reaction
 Air emphysema

3. Spillage on clothing

4. 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

5. 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.

6.  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

7. 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.

8. 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.

9. 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.