Iranian Endodontic Journal

Abstract

Sodium hypochlorite (NaOCl) accidents are a serious iatrogenic complication in endodontic treatment that may cause severe tissue damage, life-threatening conditions, long-term sequelae, and medico-legal consequences. This scoping review aimed to provide a comprehensive overview of the management and prevention of NaOCl accidents. A systematic search of major databases, including PubMed/Medline, Web of Science, Scopus, Cochrane, Google Scholar, ScienceDirect, LILACS, and Crossref, was conducted using relevant MeSH terms and keywords. After screening and eligibility assessment, 262 articles comprising case reports, case series, original studies, and review articles were included. The findings indicate that although many patients experience complete recovery, the clinical course and outcomes of NaOCl accidents remain unpredictable. Some cases may result in incomplete recovery, persistent symptoms, or permanent adverse effects. Therefore, prompt recognition and immediate intervention are essential. Initial management should focus on minimizing tissue damage through rapid detection, aspiration and/or dilution of the extruded irrigant, symptom control, and appropriate referral when necessary. Because clinical manifestations often worsen during the early stages, careful monitoring, detailed documentation, and regular follow-up are critical throughout the progression and recovery phases. Extended management may be required for patients with short- or long-term complications. The review also emphasizes that prevention remains the most effective strategy. Clinicians should adopt preventive measures related to patient assessment, tooth selection, irrigant characteristics, and irrigation techniques before and during intracanal irrigation. Adherence to safe irrigation protocols can substantially reduce the risk of NaOCl extrusion and associated complications. In conclusion, NaOCl accidents represent potentially serious events that require immediate and structured management. Given their unpredictable nature and possible long-term consequences, clinicians must be prepared to respond promptly and monitor patients closely. Future efforts should focus on standardized reporting of NaOCl accidents and high-quality clinical research to strengthen the evidence base and improve protocols for their prevention and management.