16/01/2020
Starting with the Signs and Symptoms that one can encounter during Accidental Hypo extrusion...
1. To start with, there will be immediate severe pain to the patient.
2. Profuse bleeding from the root canal can be seen.
3. Redness over the affected side of the face along with swelling and edema.
4. After few hours,signs of ecchymosis or even paresthesia can occur in severe cases.
Treatment wud include...
1. Abort the further procedure.
2. Immediately forceful irrigation of the canal with copious amount of saline or lignocaine solution so as to neutralize the effect of hypo to some extent & reduce the pain.
3. Analgesics to reduce the pain.
4. Corticosteroids can be added to reduce the localized inflammation.
5. Antibiotics in case of medically compromised patient or to prevent secondary infection.
6. Extraoral cold compression immediately following the accident to reduce the swelling.
7. After 24 hours, Warm compression and frequent warm saline mouth rinses to facilitate localized healing.
Bt all this will just provide symptomatic relief to the patients....Hypo accidents take their own sweet time to recover.
If ecchymosis occurs then gradually after few days the colour changes from red to bluish grey and then gradually disappears over a period of a week..
So at the end..what matters most is effective communication with the patient, constantly being in contact with him and reassuring him that things will improve gradually with time.
But as we always say that
Prevention is better than Cure....
To prevent hypo accidents...
1. All syringes to be duly named after the irrigant it contains to avoid interchanging of solutions during use.
2. We should educate our assistants to fill up the syringes with utmost care and the potential risk involved if care is not taken..
3. A good pre endo built up alongwith rubber dam isolation is must to avoid any leakage of solution & accidental spills during use.
4. Use of protective eyewear for both the dentist & the patient.
4. Always use a Luer lock needle & syringe so as to avoid opening of needle from the syringe while dispensing the irrigant inside the canal.
5. Irrigant should be delivered using 30 gauge Side vented needles in a slow up & down motion inside the canal making sure at any point of time, the needle is always around 1 to 2 mm short of WL.
6. At no point of time, the irrigating side venting needle should be wedged inside the canal as wedging the tip inside the canal during irrigation increases the chances of apical extrusion of the hypochlorite solution.
7. The delivery of the irrigant should be very slow & with very little pressure Around 3 ml of hypo solution to be dispensed in around 2 mins.
Hope this Helps..
Dr.Ganesh Maurya
Mumbai.
