Sodium hypochlorite goes in the periapex during irrigation when - Short roots open apex, Over instrumented apex straight roots. USE OF FRONT VENTED NEEDLES 
Error in length determination. How to identify or differentiate sodium hypochlorite accident from pulpal or periapical pain? Sudden pain immediately after irrigation in an otherwise painless tooth. Sudden oozing of blood from an otherwise cleaned canal swelling immediately after irrigation. Colour changes in outer skin related to the tooth PRECAUTIONS: ALWAYS USE A SIDE VENTED NEEDLE for irrigation Keep the length of the irrigating needle 2mm short of working length inside the canal (correct length determination using apex locator important) Do not push the irrigant with pressure (the needle should be loose in the canal, not locked) dispense the irrigant very slowly. Focus on the irrigation. How to manage a patient with sodium hypochlorite accident. Reassure the patient and tell them the truth, “It is just medicine gone beyond your tooth. You will be fine soon.” Immediately irrigate with abundant saline continuously. Local anesthetic solution with adrenaline can be used as a first irrigant, if blood oozing from the canal. If swelling present, give open dressing, recall after 12 hours, re-irrigate and give closed dressing advice corticosteroid at least for 3 days. (control inflammation) Advise painkillers, if pain is terrible Tramadol may be prescribed. Mild antibiotics are prescribed (sodium hypochlorite if goes, in large quantities, periapically may cause tissue necrosis making it susceptible to infection) Advise ice pack application for a day; recall and reassure. It may take 4 days to 3 weeks for complete recovery depending on severity. Prevention is always better than cure. My patient immediately post sodium hypochlorite accident with upper left molar.
Error in length determination. How to identify or differentiate sodium hypochlorite accident from pulpal or periapical pain? Sudden pain immediately after irrigation in an otherwise painless tooth. Sudden oozing of blood from an otherwise cleaned canal swelling immediately after irrigation. Colour changes in outer skin related to the tooth PRECAUTIONS: ALWAYS USE A SIDE VENTED NEEDLE for irrigation Keep the length of the irrigating needle 2mm short of working length inside the canal (correct length determination using apex locator important) Do not push the irrigant with pressure (the needle should be loose in the canal, not locked) dispense the irrigant very slowly. Focus on the irrigation. How to manage a patient with sodium hypochlorite accident. Reassure the patient and tell them the truth, “It is just medicine gone beyond your tooth. You will be fine soon.” Immediately irrigate with abundant saline continuously. Local anesthetic solution with adrenaline can be used as a first irrigant, if blood oozing from the canal. If swelling present, give open dressing, recall after 12 hours, re-irrigate and give closed dressing advice corticosteroid at least for 3 days. (control inflammation) Advise painkillers, if pain is terrible Tramadol may be prescribed. Mild antibiotics are prescribed (sodium hypochlorite if goes, in large quantities, periapically may cause tissue necrosis making it susceptible to infection) Advise ice pack application for a day; recall and reassure. It may take 4 days to 3 weeks for complete recovery depending on severity. Prevention is always better than cure. My patient immediately post sodium hypochlorite accident with upper left molar. DISCLAIMER : “Views expressed above are the author's own.”