1. Benefits of Using Irrigants in Root Canal Treatment:
    • 1. Flush out debris
    • 2. Lubricate the canal
    • 3. Dissolve organic and inorganic tissue
    • 4. Prevent the formation of a smear layer during instrumentation or dissolve it once it has been formed
  2. Biologic function of irrigants:
    • 1. Have a high efficacy against anaerobic and facultative microorganisms in their planktonic state and in biofilms
    • 2. Inactivate endotoxin.
    • 3. Be non-toxic when they come in contact with vital tissues
    • 4. Not cause anaphylactic reaction.
  3. Benefits of Using Irrigants in Root Canal Treatment:
    • 1. Removal of particulate debris and wetting of the canal walls.
    • 2. Destruction of microorganisms.
    • 3. Dissolution of organic debris.
    • 4. Opening of dentinal tubules by removal of the smear layer.
    • 5. Disinfection and cleaning of areas inaccessible to endodontic instruments
  4. Properties of an Ideal Irrigant for Root Canal Treatment:
    1. Be an effective germicide and fungicide.

    2. Be non-irritating to the periapical tissues.

    3. Remain stable in solution.

    4. Have a prolonged anti-microbial effect.

    5. Be active in the presence of blood, serum, and protein derivatives of tissue.

    6. Have low surface tension.

    7. Not interfere with repair of periapical tissues.

    8. Not stain tooth structure.

    9. Be capable of inactivation in a culture medium.

    10. Not induce a cell-mediated immune response.

    11. Be able to completely remove the smear layer and be able to disinfect the underlying dentin and its tubules.

    12. Be non-antigenic, non-toxic, and non-carcinogenic to tissue cells surrounding the tooth.

    13. Have no adverse effects on the physical properties of exposed dentin.

    14. Have no adverse effects on the sealing ability of filling materials.

    15. Have a convenient application.

    16. Be relatively inexpensive.
  5. What is the mode of action for NaOCl?
    When NaOCl contacts tissue proteins, nitrogen, formaldehyde, and acetaldehyde are formed.  Peptide links are fragmented and proteins disintegrate, permitting hydrogen in the amino groups (-NH-) to be replaced by chlorine (-NCl-) forming chloramines.
  6. NaOCL Accident
    • 1. Severe pain.
    • 2. Edema of neighboring soft tissues.
    • 3. Possible extension of edema over injured half of face and upper lip.
    • 4. Profuse bleeding from root canal.
    • 5. Profuse interstitial Bleeding with hemorrhage of skin and mucosa (ecchymosis).
    • 6. Chlorine taste and irritation of throat after injection into maxillary sinus.
    • 7. Secondary infection is possible.
    • 8. Reversible anesthesia or paresthesia is possible.
  7. NaOCl Accident Management:
    • 1. Inform patient and control pain with local anesthesia and analgesics.
    • 2. Apply cold compresses to reduce swelling.
    • 3. After 1 day, warm compresses and frequent warm mouth rinses for stimulation of local systemic circulation should be used.
    • 4. Patients should be recalled daily to monitor recovery.
    • 5. The use of ABX is not obligatory and is recommended only in cases of high risk or evidence of secondary infection.
    • 6. The administration of antihistamine is not obligatory.  The use of corticosteroids is controversial.
    • 7. Further endodontic therapy with sterile saline or CHX as root canal irrigants and referral to a hospital in case of worsening symptoms.
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