@article{FOMM119165,
author = {Parsa Hosseini-Jahromi and Aviv Ouanounou},
title = {Sodium hypochlorite accident in dentistry: a narrative review of etiology, diagnosis and management},
journal = {Frontiers of Oral and Maxillofacial Medicine},
volume = {8},
number = {0},
year = {2026},
keywords = {},
abstract = {Background and Objective: Sodium hypochlorite (NaOCl) remains the most widely used solution in endodontic treatment due to its unique properties. Despite its beneficial role, it is highly cytotoxic, and improper handling can lead to hypochlorite injuries. The objective of this narrative review is to synthesize current knowledge into a structured, clinician-focused framework to enhance understanding of the etiology of such injuries, improve early diagnosis, and increase awareness of appropriate management protocols.Methods: A narrative review of English-language endodontic literature was conducted using databases such as PubMed, Ovid MEDLINE, Embase, and Google Scholar to identify relevant articles and guidelines, prioritizing those published since 2000.Key Content and Findings: Endodontic therapy is a widely sought-after dental treatment aimed at preserving the natural dentition. Although various compounds have been proposed as endodontic irrigants, NaOCl remains the most widely used solution due to its unique properties. Mishandling this irrigant can lead to hypochlorite accidents associated with improper irrigation techniques, excessive apical pressure, wedged needles, compromised anatomical barriers, and inadequate tooth isolation. The principal mechanisms of injury include extrusion beyond the apical foramen, spillage onto soft tissues, and anatomical spaces. Multiple risk factors increase susceptibility to hypochlorite accidents and are categorized into tooth-, irrigant-, operator-, and patient-related factors. Diagnosis requires a comprehensive clinical history in addition to a thorough examination. A typical clinical presentation is characterized by a recent history of endodontic treatment followed by a rapid onset of pain and burning sensation. Additional complications may include ecchymosis, necrosis, paresthesia, sinus involvement, and respiratory compromise. While prevention and adherence to standards of practice remain the best strategy, the literature outlines severity- specific management protocols.Conclusions: Vigilance and proactive management of hypochlorite use should be standard practice, not only to minimize patient risk and improve procedural outcomes but also to avoid the ethical and legal implications associated with hypochlorite accidents. Therefore, understanding the properties of NaOCl, etiology of hypochlorite accidents, risk factors associated with this injury, prevention strategies and management guidelines is essential for operators to safely utilize this effective irrigant within their practice.},
issn = {2664-777X}, url = {https://fomm.amegroups.org/article/view/119165}
}