Dental Tribune United Kingdom Edition

to country. In Scandinavia the is- sue of toxicity and possible prob- lems with bleach have led practi- tioners to err on the side of caution and concentrations of 0.5-1 per cent are traditionally used. In the United States on the other hand, dentists tend to use concentra- tions of 5.25 per cent, arguing that this is the most effective solution as a tissue solvent. In the United Kingdom we generally use 2.5 per cent but can increase effectiveness by either heating it or using ultra- sonics. The bleach can be warmed in a bottle warmer and its effect is further increased by constantly flushing the solution through the canals rather than just letting it sit passively in the canals. Nickel Titanium instruments can lead us to falsely assume that we have fully prepared the canal. However, often the walls have not even been touched due to the files staying very centred. The speed at which the canal system is pre- pared also means that our irrig- ants may not have had sufficient time to be effective. The optimum soaking for this should be half an hour to ensure that the tissues are fully dissolved and the bacteria are killed - no matter how quickly the canals are prepared with the NiTi files. Recently a new file system has been launched - the SAF (self adjusting files). These are hollow files shaped as a thin metal lattice that are very flexible and prepare all the walls especially in very ir- regular shapes. Sodium hypochlo- rite is continuously pumped through the files as the walls are being prepared and the pub- lished data is very promising. The manufacturers recommend four minutes preparation per canal. No matter which system is used it is important to remem- ber that sodium hypochlorite is a very toxic fluid. If it is extruded out of a canal under pressure it can cause severe complica- tions. There have been recent cases of severe bony necrosis and nerve damage but even small amounts can cause pain, bleeding and marked bruising. If a hypochlorite accident occurs the patient will get sud- den pain and bleed profuse- ly. The best plan of action in this situation is to remain calm and if necessary top up the lo- cal anaesthetic. The canal should be rinsed out with saline and the contents aspirated to di- lute the irritant. Antibiotics may be indicated as well as analgesics and ice packs for the bruising. As previously mentioned, high concentrations of bleach are used to dissolve tissues. Obviously, the higher the strength of the bleach, the higher the danger it potential- ly poses to the patient. But for the bleach to be effective it needs to be placedwithin2mmoftheapexand so precautions have to be taken. I always inject bleach slowly, un- der low pressure, always ensuring that the needle is moving so that it doesn’t become jammed. I am always very cautious with short teeth and immature teeth with open apices and tend to place a rubber stop on the needle so that I always know where I am. As is the case in all treat- ments, prevention is always better than cure. I advocate the use of sodium hypochlorite as the only effective way of disinfect- ing root canals, but it must be used with care and caution to avoid problems from occurring. DT About the author Dr Michael Sul- tan BDS MSc DFO FICD is a specialist in Endodontics and the Clinical Direc- tor of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for 5 years before commencing specialist studies at Guy’s hospital, London. He completed his MSc and in Endodon- tics in 1993 and worked as an in-house endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist register in Endodontics in 1999 and has lectured extensively to postgradu- ate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. In 2008 he became clinical director of EndoCare - a group of specialist practices. For further information please call EndoCare on 0844 893 2020 or visit www.endocare.co.uk ‘No matter which system is used it is impor- tant to remember that sodium hypochlorite is a very toxic fluid’ June 13-19, 201122 United Kingdom EditionClinical NEW DIGIXPAD COMPACT DENTAL IMAGING AND DIAGNOSTIC SYSTEM DigixPad provides a the ideal solution for any practitioner wishing to upgrade to Digital X-ray Imaging without the need for costly and complex PC integration and networking. Providing quick and easy chairside image capture and manipulation, DigixPad from eschmannDirect will save you time and money and will easily integrate into your surgery. 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