Anatomy of sodium hypochlorite accidents involving facial ecchymosis - A review

Wan Chun Zhu, Jacqueline Gyamfi, Li Na Niu, G. John Schoeffel, Si Ying Liu, Filippo Santarcangelo, Sara Khan, Kelvin C.Y. Tay, David Henry Pashley, Franklin Chi Meng Tay

Research output: Contribution to journalReview articlepeer-review

80 Scopus citations


Objectives Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur. Methods To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavour to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed. Results By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-collapsible venous sinusoids within the cancellous bone is presented. Conclusions Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal débridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system.

Original languageEnglish (US)
Pages (from-to)935-948
Number of pages14
JournalJournal of Dentistry
Issue number11
StatePublished - Nov 2013


  • Central venous pressure
  • Ecchymosis
  • Facial vein
  • Intraosseous space
  • Positive fluid pressure
  • Root canal treatment
  • Sodium hypochlorite

ASJC Scopus subject areas

  • Dentistry(all)


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