Consequências e condutas clínicas frente a acidentes por extravasamento de NaClO em endodontias

Autores/as

  • Sirlei Vaz de Freitas Unidade de Ensino Continuada em Saúde
  • Luiz Fernando Tomazinho Unidade de Ensino Continuada em Saúde
  • Mara Ilka Holanda de Medeiros Batista Centro Universitário de João Pessoa (UNIPE)
  • Alessandra Albuquerque Tavares Carvalho Universidade Federal de Pernambuco
  • Marcília Ribeiro Paulino Centro Universitário Dr. Leão Sampaio (UNILEAO)

Resumen

La terapia endodóntica prevé la descontaminación químico-mecánica de los canales radiculares, siendo el hipoclorito de sodio (NaClO) la sustancia química más utilizada. Se buscó realizar una revisión crítica de la literatura sobre las consecuencias de accidentes por extravasación de NaClO durante el tratamiento endodóntico y las conductas clínicas necesarias en esos casos. Las búsquedas de bases de datos fueron realizadas en Scielo y Lilacs con descriptores em portugués, y la base de datos PubMed con descriptores en Inglés, obteniéndose 98 registros de artículos disponibles para la lectura completa, publicados desde 2003 hasta 2018. Se incluyeron aquellos cuya temática respondía a los cuestionamientos en discusión: HClO como irrigante endodóntico; factores que afectan la extrusión del hipoclorito en tratamientos endodónticos, consecuencias y manejo clínico en caso de extravasación del riego. La extrusión del hipoclorito más allá del agujero apical conduce a la destrucción del tejido y la necrosis. Sin embargo, son pocos los estudios con recomendaciones después de accidentes por extravasación de NaClO en la clínica endodôntica. En casos de accidentes, se debe aspirar la sustancia y lavar el área con solución salina estéril. No existe un protocolo único para la intervención, se debe evaluar el alcance y la gravedad del accidente. La prioridad es el alivio del dolor, el control del edema y la prevención de infecciones secundarias. El profesional debe atentar a la posibilidad diaria
de accidentes y adoptar medidas preventivas.

 

Consecuencias y conductas clínicas frente a accidentes por extravasación de NaClO en endodoncias

Endodontic therapy predicts the chemical-mechanical decontamination of the root canals sodium hypochlorite (NaClO) being the most commonly used chemical. A critical review of the literature on the consequences of accidentsby extravasation of NaClO during endodontic treatments and clinical necessary procedures in such cases. We searched the Scielo and Lilacs databases with descriptors in Portuguese and in the PubMed database with descriptors in English, being obtained 98 articles records available for complete reading, published between 2003-2018. Those whose subjects answered the questions in discussion were included: HClO as an endodontic irrigator; factors that affect the extrusion of hypochlorite in endodontic treatments, consequences and clinical management in case of extravasation of the irrigant. The extrusion of hypochlorite beyond the apical foramen leads to tissue destruction and necrosis. However, there are few studies with recommendations after accidents due to extravasation of NaClO in the endodontic clinic. In cases of accidents, the substance should be aspirated and the area washed with sterile saline. There is no single protocol for intervention, the extent and severity of the accident must be assessed. The priority is pain relief, edema control and prevention of secondary infections. The professional must take into account the daily possibility of accidents and take preventive measures. 

Keywords: endodontics, accident prevention, root canal irrigants, sodium hypochlorite.

 

Clinical consequences and behaviors in relation to accidents concerning extravasation of NaClO in endodontics

A terapia endodôntica prevê a descontaminação químico-mecânica dos canais radiculares, sendo o hipoclorito de sódio (NaClO) a substância química mais utilizada. Buscou-se realizar uma revisão crítica da literatura sobre as consequências de acidentes por extravasamento de NaClO durante o tratamento endodôntico e as condutas clínicas necessárias nesses casos. Foram realizadas buscas nas bases de dados Scielo e Lilacs com descritores em português, e na base de dados PubMed com descritoresnem inglês, sendo obtidos 98 registros de artigos disponíveis para leitura completa, publicados de 2003-2018. Foram Incluídos aqueles cuja temática respondesse aos questionamentos em discussão: HClO como irrigante endodôntico; fatores que
afetam a extrusão do hipoclorito em tratamentos endodônticos, consequências e manejo clínico em caso de extravasamento do irrigante. A extrusão do hipoclorito para além do forame apical leva a destruição e necrose tecidual. Porém, são poucos os estudos com recomendações após acidentes por extravasamento de NaClO na clínica endodôntica. Em casos de acidentes a substância deve ser aspirada e o local lavado abundantemente com solução salina estéril. Não há um protocolo único para intervenção, a extensão e gravidade do acidente devem ser avaliadas. A prioridade é o alívio da dor, controle de edema e prevenção de infecções secundárias. O profissional
deve atentar à possibilidade diária de acidentes e adotar medidas preventivas.

Palavras-chave: endodontia, prevenção de acidentes, irrigantes do canal radicular, hipoclorito de sódio.

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2020-04-27

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