Survey on the Pattern of Practice in Using Sodium Hypochlorite as Root Canal Irrigant
DOI:
https://doi.org/10.33102/mjosht.446Keywords:
Domestic bleach, Endodontic Irrigant, Hypochlorite accident, MalaysiaAbstract
Sodium hypochlorite (NaOCl) is the most used endodontic irrigant due to its antimicrobial and organic tissue-dissolving properties. However, NaOCl solutions are unstable; exposure to light, heat, air, metals, and organic substances can reduce the available chlorine concentration with concomitant loss of antimicrobial and tissue-dissolving properties. NaOCl delivery mode during endodontic treatment plays a role in its efficacy in reaching the intricate anatomy of the root canal system. This study sought to investigate the practice patterns of Malaysian dental practitioners concerning the type, storage, dilution, and delivery of NaOCl in their clinical settings. A cross-sectional study was conducted among Malaysian dental practitioners via the online platform. Ninety-seven respondents were recruited, which comprised 88.7% of general dental practitioners and 11.3% of dental specialists. The most common type of NaOCl used is domestic bleach, with the majority using concentrations of 3.5%–6%. Most dental practitioners store domestic bleach in a cupboard and use it diluted. If it is diluted, a majority of the NaOCl is diluted every time before each treatment. The closed-ended side-vented needle is the most common needle used for endodontic irrigation, and it is 30G in size. Manual activation is used to irrigate the canal. The majority of dental practitioners practise proper NaOCl handling to preserve its antimicrobial properties.
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U. Krishnan, S. Saji, R. Clarkson, R. Lalloo, and A. J. Moule, “Free active chlorine in sodium hypochlorite solutions admixed with octenidine, smearoff, chlorhexidine, and EDTA,” J. Endod., vol. 43, no. 8, pp. 1354-1359, Aug. 2017, doi: 10.1016/j.joen.2017.03.034.
C. Estrela, C. R. A Estrela, E. L. Barbin, J. C. E. Spanó, M. A. Marchesan, and J. D. Pécora, “Mechanism of action of sodium hypochlorite,” Braz. Dent. J., vol. 13, no. 2, pp. 113-117, 2002, doi: 10.1590/s0103-64402002000200007.
J. Dutner, P. Mines, and A. Anderson, “Irrigation trends among American Association of Endodontists members: A web-based survey,” J. Endod., vol. 38, no. 1, pp. 37-40, Sep. 2021, doi: 10.1016/j.joen.2011.08.013.
A. R. Pai, “Factors influencing the occurrence and progress of sodium hypochlorite accident: A narrative and update review.” J. Conserv. Dent., vol. 26, no. 1, pp. 3-11, 2023, doi: 10.4103/jcd.jcd_422_22.
R. Ordinola-Zapata, C. M. Bramante, R. M. Aprecio, R. Handysides, and D. E. Jaramillo, “Biofilm removal by 6% sodium hypochlorite activated by different irrigation techniques,” Int. Endod. J., vol. 47, no. 7, pp. 659-666, Jul. 2014, doi: 10.1111/iej.12202.
W. M. A. Wan Ahmad, M. S. Mohd Ibrahim, A. Husein, and M. F. Khamis, Sample size calculations made easy using G*Power, Pulau Pinang, Malaysia: Penerbit USM, 2018.
M. S. AL-Zahrani and A. G. AL-Zahrani, “Sodium hypochlorite accident in endodontics: An update review,” Int. J. Dent. Oral Health, vol. 2, no. 2, pp. 1-4, 2016, doi: 10.16966/2378-7090.168.
S. O. Basudan, “Sodium hypochlorite use, storage, and delivery methods: A survey,” Saudi Endod. J., vol. 9, no. 1, pp. 27-33, 2019, doi: 10.4103/sej.sej_38_18.
R. M. Clarkson, H. M. Podlich, N. W. Savage, and A. J. Moule, “A survey of sodium hypochlorite use by general dental practitioners and endodontists in Australia,” Aust. Dent. J., vol. 48, no. 1, pp. 20-26, Mar. 2003, doi: 10.1111/j.1834-7819.2003.tb00004.x.
H. Jungbluth C. Peters, O. Peters, B. Sener, and M. Zehnder, “Physicochemical and pulp tissue dissolution properties of some household bleach brands compared with a dental sodium hypochlorite solution,” J. Endod., vol. 38, no. 3, pp. 372-375, Mar. 2012, doi: 10.1016/j.joen.2011.12.013.
E. A. Saberi, N. Farhad-Mollashahi, and M. Saberi, “Difference between the actual and labeled concentrations of several domestic brands of sodium hypochlorite,” Iran. Endod. J., vol. 14, no. 2, pp. 139-143, 2019, doi: 10.22037/iej.v14i2.23120.
S. V. van der Waal, N. E. van Dusseldorp, and J. J. de Soet, “An evaluation of the accuracy of labeling of percent sodium hypochlorite on various commercial and professional sources: Is sodium hypochlorite from these sources equally suitable for endodontic irrigation?” J. Endod., vol. 40, no. 12, pp. 2049-2052, Dec. 2014, doi: 10.1016/j.joen.2014.08.021.
A. A. Jawami, E. Soo, D. Abdullah, A. K. C. Liew, and M. Abd Rahman, “Metal contamination and stability of household bleach and specially-formulated sodium hypochlorite for endodontic use,” Sains Malays., vol. 51, no. 1, pp. 307-313, 2022, doi: 10.17576/jsm-2022-5101-25.
R. M. Clarkson, A. J. Moule, and H. M. Podlich, “The shelf-life of sodium hypochlorite irrigating solutions,” Aust. Dent. J., vol. 46, no. 4, pp. 269-276, Dec. 2001, doi: 10.1111/j.1834-7819.2001.tb00291.x.
B. J. Chaúque and M. B. Rott, “Photolysis of sodium chloride and sodium hypochlorite by ultraviolet light inactivates the trophozoites and cysts of Acanthamoeba castellanii in the water matrix,” J. Water Health, vol. 19, no. 1, pp. 190-202, Feb. 2021, doi: 10.2166/wh.2020.401.
B. M. B. Costa, et al., “Evaluation of ph stability, concentration and antimicrobial activity in commercial brands of sodium hypochlorite solution,” Res. Soc. Dev., vol. 10, no. 3, pp. e54910313658, 2021, doi: 10.33448/rsd-v10i3.13658.
M. A. Zazouli, Y. Hashempour, and N. Dashtban, “Investigation the effect of environmental factors on the sodium hypochlorite solution stability as disinfection of environmental surfaces,” J. Mazandaran Univ. Med. Sci., vol. 33, no. 227, pp. 274-286, Nov. 2023. Available: http://jmums.mazums.ac.ir/article-1-19499-en.html
B. Pişkin and M. Türkün, “Stability of various sodium hypochlorite solutions,” J. Endod., vol. 21, no. 5, 253-255, May 1995, doi: 10.1016/S0099-2399(06)80991-X.
Center for Disease Control and Prevention. (2024). Cleaning and disinfecting with bleach. [Online]. Available: https://www.cdc.gov/hygiene/about/cleaning-and-disinfecting-with-bleach.html
B. R. Johnson and N. A. Remeikis, “Effective shelf-life of prepared sodium hypochlorite solution,” J. Endod., vol. 19, no. 1, pp. 40-43, Jan. 1993, doi: 10.1016/S0099-2399(06)81040-X.
C. K. Gow, C. Weinhouse, G. O. Johnson, and K. E. Saunders, “Stability of free available chlorine levels in dilute sodium hypochlorite solutions over a 6-week period,” J. Am. Assoc. Lab. Anim. Sci., vol. 61, no. 2, pp. 181-187, Mar 2022, doi: 10.30802/AALAS-JAALAS-21-000080.
C. Boutsioukis, B. Verhaagen, M. Versluis, E. Kastrinakis, P. R. Wesselink, and L. W. M. van der Sluis, “Evaluation of irrigant flow in the root canal using different needle types by an unsteady computational fluid dynamics model,” J. Endod., vol. 36, no. 5, pp. 875-879, May 2010, doi: 10.1016/j.joen.2009.12.026.
C. Boutsioukis, et al., “The effect of needle insertion depth on the irrigant flow in the root canal: evaluation using an unsteady computational fluid dynamics model,” J. Endod., vol. 36, no. 10, pp. 1664-1668, Oct. 2010, doi: 10.1016/j.joen.2010.06.023.
C. Boutsioukis and P. G. Nova, “Syringe irrigation in minimally shaped root canals using 3 endodontic needles: A computational fluid dynamics study,” J. Endod., vol. 47, no. 9, pp. 1487-1495, Sep. 2021, doi: 10.1016/j.joen.2021.06.001.
C. Boutsioukis, Z. Psimma, and E. Kastrinakis, “The effect of flow rate and agitation technique on irrigant extrusion ex vivo,” Int. Endod. J., vol. 47, no. 5, pp. 487-496, May 2014, doi: 10.1111/iej.12176.
M. Khare, B. S. Suprabha, A. Yadav, R. Shenoy, K. Boaz, and A. Rao, “Effectiveness of ultrasonic and manual dynamic agitation techniques in irrigant penetration: An in vitro study,” World J. Dent., vol. 8, no. 3, pp. 207-212, 2017, doi: 10.5005/jp-journals-10015-1439.
R. S. Kumar, et al., “Effectiveness of various irrigant activation techniques on the penetration of sodium hypochlorite into lateral canals of mature permanent teeth: A systematic review and meta-analysis,” Saudi Dent. J., vol. 35, no. 1, pp. 1-23, Jan. 2023, doi: 10.1016/j.sdentj.2022.12.004.
F. Puleio, A. S. Lizio, V. Coppini, R. Lo Giudice, and G. Lo Giudice, “CBCT-based assessment of vapor lock effects on endodontic disinfection,” Appl. Sci., vol. 13, no. 17, pp. 9542, Aug. 2023, doi: 10.3390/app13179542.
P. P. Machtou, “Manual dynamic activation technique,” Clin. Dent. Rev., vol. 2, pp. 1-5, Sept. 2018, doi: 10.1007/s41894-018-0034-4.
S. Paixão, P. S. Gomes, M. H. Fernandes, C. Rodrigues, and L. Grenho, “Comparative evaluation of ultrasonic and sonic irrigant activation systems: Assessing extrusion risk, debridement, and biofilm removal in distinct apical preparation sizes,” Appl Sci., vol. 14, no. 9, pp. 3904, Jan. 2024, doi: 10.3390/app14093904.
X. Zou, X. Zheng, Y. Liang, C. Zhang, B. Fan, J. Liang, J. Ling, Z. Bian, Q. Yu, B. Hou, and Z. Chen, “Expert consensus on irrigation and intracanal medication in root canal therapy,” Int. J. Oral Sci., vol. 16, no. 1, pp. 23. Mar. 2024, doi: 10.1038/s41368-024-00280-5.
D. J. Kleier, R. E. Averbach, and O. Mehdipour, “The sodium hypochlorite accident: experience of diplomates of the American Board of Endodontics,” J. Endod., vol. 34, no. 11, pp. 1346-1350, Nov. 2008, doi: 10.1016/j.joen.2008.07.021.
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