Re: RCT and bleach

[Guest guest]

thanx lyud...this was really informative...not just from exam point of view....but very good info.for practice!!tcsupsFrom: Lyudmyla Huhley <huhley2006@...>Subject: RCT and bleach Date: Wednesday, December 29, 2010, 11:40 PM

Dentist faces misconduct hearing

A dentist punctured a patient's nose with a needle, a misconduct hearing has been told. Joanna Chyzy, 34, from Collin, near Dumfries, faces allegations involving nine patients while working at a practice in Somerset. The General Dental Council hearing was also told that she used concentrated bleach during root canal treatment. Ms Chyzy has admitted nine counts of misconduct but denies the detail of some of them. The hearing continues. Ian Stern, for the GDC, told the hearing in London that during a consultation with one patient Ms Chyzy put a needle in the woman's gum without consent. 'Drops of blood' "As soon as the needle was put in, the patient felt an increasing intense pain. She was waving her hands and making noises, but Ms Chyzy continued," he said. "Eventually Ms Chyzy withdrew the needle. The woman had no sensation in her throat but could feel her gum. "She noticed large drops of blood coming out her nose." Ms Chyzy left another patient bleeding after she drilled through the wrong part of the tooth, the hearing was told. Bleach solution She then used a 5% bleach solution during root canal treatment, when the normal concentration is between 1.5% and 2%. The bleach seeped into the mouth, leaving the patient with swelling, bruising and possible nerve damage. The incidents are alleged to have taken place between 10 February and 17 November last year. Ms Chyzy has admitted nine counts of misconduct but denies elements of most of the claims.

Hi guys

Very useful infor.

Taken from dental juice

This page is a brief aide-memoire on the risks of using of bleach as a canal irrigant in endodontics. Every procedure invloves risks, and risk management is an important part of being a dental professional.If you don't manage the risk effectively, see what can happen here...http://news.bbc.co.uk/go/em/fr/-/1/hi/scotland/south_of_scotland/6336321.stm Bleach is used extensively in endodontics, usually as 1% to 3% Sodium Hypochlorite Soution. It is the gold standard irrigant for canal disinfection. The benefits of using it in a careful professional manner outweigh the risks. HOWEVER

Bleach is alkaline, and will burn the mucosa if spilt into the mouth.

If swallowed, it will burn the oesophagus.

If inhaled, it will burn the lungs (and chlorine gas may be released).

If splashed, it will burn the eyes and nostrils.

If injected through the apex of a tooth, it will destroy the peri-radicular tissues, often leading to massive oedema (swelling), tissue necrosis, and risk of serious infection.Dental professionals using bleach have to accept the extra personal responsibility this brings, by knowing how to manage a bleach accident, and by using a careful operating technique that minimises the risks. Correct use of bleach:

Protect patient's clothes with a waterproof covering.

Place an absorbent bib over the waterproof.

Ensure patient is wearing well-fitting safety spectacles. Do not let them wear their own glasses.

Rubber dam is mandatory, and should be sealed with Caulk

The Hypochlorite syringes must be clearly marked, and only 3/4 full.

The delivery needle must be side-venting.

The delivery needle should be bent 5 mm short of the working length, so it can not be introduced too far accidentally.

Bleach is further introduced into the apical region with a file - not with the syringe plunger.

Bleach is delivered very slowly, and aspirated by an assistant using a small bore aspirator tip. The tip is held distal to, and as close as possible to the access cavity. Bleach should not be delivered unless an assistant is present.

As an extra precaution, a pledget of cotton wool may be held distal to the tooth, to absorb an accidental minor leak.

Inform the patient of the procedure, and tell them to alert you if they can taste bleach.

Bleach must not be used in a tooth with a perforation.Immediate Management of an intra-oral bleach accident

Remove the dam frame as quickly as possible, and lay the dam to the side of the mouth.

Sit the patient up.

Have them rinse out copiously.

Have them drink and swallow lots of water.

If possible, discourage vomiting. This may re-burn the oesophagus (on the way up) if any has been swallowed, and increase the risk of inhalation.

Dress the access cavity as quickly as possible with cotton wool and temporary filling, to protect the canals from saliva while the accident is managed.Bleach in eyes

Irrigate copiously for 15 minutes with saline or water.

Consider involvement of patient's Medical Practitioner, or Emergency Services.Bleach injection through the apexManagement suggested by Hales JJ, CR, Everett AP, SH. Treatment protocol for the management of a sodium hypochlorite accident during endodontic therapy. Gen Dent 2001; 49(3):278–81.

This will become apparent very quickly due to rapid swelling, bruising, and severe burning pain.

There may be sudden copious bleeding from the canal.

Provide immediate pain relief by administering local anesthesia to the affected area.

Allow the drainage of the inflammatory exudate and dilute the NaOCl by irrigating the canal system with normal saline solution or water.

Reassure the patient and inform him or her of the cause and severity of the complications.

Reduce swelling by applying cold compresses in 15-minute intervals for the first 24 hours, followed by warm compresses thereafter.

Prescribe prophylactic antibiotics to prevent secondary infection.

In consultation with the patient's medical practitioner, consider prescribing acetaminophen-based narcotic analgesics to control pain, and steroid medication to control inflammatory reaction.

Set up regular recall appointments to monitor the patient’s recovery and complete the endodontic therapy upon resolution of the acute symptoms.SincerelyLyudmylaHuhleyhuhley2006@...

[Guest guest]

Hi Lyudmyla,

About the bleach concentration, I am using 5% conenetration for all my patient .. as we r allowed to use it between 0.5 % to 5.25% NaCOH

I am folowing the north america.

I noticed in eastman course that the endondontist mention less concentration and also said studies shows that there is no difference between using less or high bleach concentration when it comes to disinfecting the canal, he mentioned a study goes to 1980 or 86...

I will post the study mentioning the effect of high concentration bleach on disinfectiong the root canal once I find it.

Regarding what happened with this dentist.. I believe that to avoid that we need proper isolation of the tooth and high suction with good dental asisstant and sure slow dispensing of of the bleach in the canal to avoid sodium hypochloride accident.

I think most of the stress the dentist face during practice is how to avoid hurting the patient and him/ herself ... it might be easy to say that with years of practice things get easier but believe me u have to be careful with each patient as u never expect what movement that patient may have during treatment which may render the treatment to disaster.

At the end just rememeber that NO body is perfect and we all might be in this dentist place.

Happy New Year.

Charlot

From: Lyudmyla Huhley <huhley2006@...> Sent: Wed, December 29, 2010 10:10:40 PMSubject: RCT and bleach

Dentist faces misconduct hearing

A dentist punctured a patient's nose with a needle, a misconduct hearing has been told. Joanna Chyzy, 34, from Collin, near Dumfries, faces allegations involving nine patients while working at a practice in Somerset. The General Dental Council hearing was also told that she used concentrated bleach during root canal treatment. Ms Chyzy has admitted nine counts of misconduct but denies the detail of some of them. The hearing continues. Ian Stern, for the GDC, told the hearing in London that during a consultation with one patient Ms Chyzy put a needle in the woman's gum without consent. 'Drops of blood' "As soon as the needle was put in, the patient felt an increasing intense pain. She was waving her hands and making noises, but Ms Chyzy continued," he said. "Eventually Ms Chyzy withdrew the needle. The woman had no sensation in her throat but could feel her gum. "She noticed large drops of blood coming out her nose." Ms Chyzy left another patient bleeding after she drilled through the wrong part of the tooth, the hearing was told. Bleach solution She then used a 5% bleach solution during root canal treatment, when the normal concentration is between 1.5% and 2%. The bleach seeped into the mouth, leaving the patient with swelling, bruising and possible nerve damage. The incidents are alleged to have taken place between 10 February and 17 November last year. Ms Chyzy has admitted nine counts of misconduct but denies elements of most of the claims.

Hi guys

Very useful infor.

Taken from dental juice

This page is a brief aide-memoire on the risks of using of bleach as a canal irrigant in endodontics. Every procedure invloves risks, and risk management is an important part of being a dental professional.If you don't manage the risk effectively, see what can happen here...http://news.bbc.co.uk/go/em/fr/-/1/hi/scotland/south_of_scotland/6336321.stm Bleach is used extensively in endodontics, usually as 1% to 3% Sodium Hypochlorite Soution. It is the gold standard irrigant for canal disinfection. The benefits of using it in a careful professional manner outweigh the risks. HOWEVER

Bleach is alkaline, and will burn the mucosa if spilt into the mouth.

If swallowed, it will burn the oesophagus.

If inhaled, it will burn the lungs (and chlorine gas may be released).

If splashed, it will burn the eyes and nostrils.

If injected through the apex of a tooth, it will destroy the peri-radicular tissues, often leading to massive oedema (swelling), tissue necrosis, and risk of serious infection.Dental professionals using bleach have to accept the extra personal responsibility this brings, by knowing how to manage a bleach accident, and by using a careful operating technique that minimises the risks. Correct use of bleach:

Protect patient's clothes with a waterproof covering.

Place an absorbent bib over the waterproof.

Ensure patient is wearing well-fitting safety spectacles. Do not let them wear their own glasses.

Rubber dam is mandatory, and should be sealed with Caulk

The Hypochlorite syringes must be clearly marked, and only 3/4 full.

The delivery needle must be side-venting.

The delivery needle should be bent 5 mm short of the working length, so it can not be introduced too far accidentally.

Bleach is further introduced into the apical region with a file - not with the syringe plunger.

Bleach is delivered very slowly, and aspirated by an assistant using a small bore aspirator tip. The tip is held distal to, and as close as possible to the access cavity. Bleach should not be delivered unless an assistant is present.

As an extra precaution, a pledget of cotton wool may be held distal to the tooth, to absorb an accidental minor leak.

Inform the patient of the procedure, and tell them to alert you if they can taste bleach.

Bleach must not be used in a tooth with a perforation.Immediate Management of an intra-oral bleach accident

Remove the dam frame as quickly as possible, and lay the dam to the side of the mouth.

Sit the patient up.

Have them rinse out copiously.

Have them drink and swallow lots of water.

If possible, discourage vomiting. This may re-burn the oesophagus (on the way up) if any has been swallowed, and increase the risk of inhalation.

Dress the access cavity as quickly as possible with cotton wool and temporary filling, to protect the canals from saliva while the accident is managed.Bleach in eyes

Irrigate copiously for 15 minutes with saline or water.

Consider involvement of patient's Medical Practitioner, or Emergency Services.Bleach injection through the apexManagement suggested by Hales JJ, CR, Everett AP, SH. Treatment protocol for the management of a sodium hypochlorite accident during endodontic therapy. Gen Dent 2001; 49(3):278–81.

This will become apparent very quickly due to rapid swelling, bruising, and severe burning pain.

There may be sudden copious bleeding from the canal.

Provide immediate pain relief by administering local anesthesia to the affected area.

Allow the drainage of the inflammatory exudate and dilute the NaOCl by irrigating the canal system with normal saline solution or water.

Reassure the patient and inform him or her of the cause and severity of the complications.

Reduce swelling by applying cold compresses in 15-minute intervals for the first 24 hours, followed by warm compresses thereafter.

Prescribe prophylactic antibiotics to prevent secondary infection.

In consultation with the patient's medical practitioner, consider prescribing acetaminophen-based narcotic analgesics to control pain, and steroid medication to control inflammatory reaction.

Set up regular recall appointments to monitor the patient’s recovery and complete the endodontic therapy upon resolution of the acute symptoms.SincerelyLyudmylaHuhleyhuhley2006@...

[Guest guest]

hi charlot...

i completely agree wid you...infact this is wut i was discussing wid one of my fellow dentists at work....that certain accidents are unavoidable...and this may also be pertaining to patients faults...and their sudden movements...that cannot be predicteed!!! i think wut scares me the most about practice abroad is this act of Patients not understanding...and taking extreme measures to the smallest of errors !!!

i havent really seen a regular use of rubber dam in my country...and it so happens...that widout its use...the minor cuts and burns...wid patients tongue movemnts....who dont allow cotton placement at the lingual sulcus...or sufficient retraction wid the mirrors...gag reflexes...fidgity habbits....land up wid incidental cuts/accidents....but fortunately they dont make a rucus....here!!!! i wonder how this system works in UK...and how cooperative the patients are in there....but i know...that such fears surely affect the levels of our confidence!

sups

From: Charlot Vam <charlotvam@...>Subject: Re: RCT and bleach Date: Saturday, January 1, 2011, 12:06 AM

Hi Lyudmyla,

About the bleach concentration, I am using 5% conenetration for all my patient .. as we r allowed to use it between 0.5 % to 5.25% NaCOH

I am folowing the north america.

I noticed in eastman course that the endondontist mention less concentration and also said studies shows that there is no difference between using less or high bleach concentration when it comes to disinfecting the canal, he mentioned a study goes to 1980 or 86...

I will post the study mentioning the effect of high concentration bleach on disinfectiong the root canal once I find it.

Regarding what happened with this dentist.. I believe that to avoid that we need proper isolation of the tooth and high suction with good dental asisstant and sure slow dispensing of of the bleach in the canal to avoid sodium hypochloride accident.

I think most of the stress the dentist face during practice is how to avoid hurting the patient and him/ herself ... it might be easy to say that with years of practice things get easier but believe me u have to be careful with each patient as u never expect what movement that patient may have during treatment which may render the treatment to disaster.

At the end just rememeber that NO body is perfect and we all might be in this dentist place.

Happy New Year.

Charlot

From: Lyudmyla Huhley <huhley2006@...> Sent: Wed, December 29, 2010 10:10:40 PMSubject: RCT and bleach

Dentist faces misconduct hearing

A dentist punctured a patient's nose with a needle, a misconduct hearing has been told. Joanna Chyzy, 34, from Collin, near Dumfries, faces allegations involving nine patients while working at a practice in Somerset. The General Dental Council hearing was also told that she used concentrated bleach during root canal treatment. Ms Chyzy has admitted nine counts of misconduct but denies the detail of some of them. The hearing continues. Ian Stern, for the GDC, told the hearing in London that during a consultation with one patient Ms Chyzy put a needle in the woman's gum without consent. 'Drops of blood' "As soon as the needle was put in, the patient felt an increasing intense pain. She was waving her hands and making noises, but Ms Chyzy continued," he said. "Eventually Ms Chyzy withdrew the needle. The woman had no sensation in her throat but could feel her gum. "She noticed large drops of blood coming out her nose." Ms Chyzy left another patient bleeding after she drilled through the wrong part of the tooth, the hearing was told. Bleach solution She then used a 5% bleach solution during root canal treatment, when the normal concentration is between 1.5% and 2%. The bleach seeped into the mouth, leaving the patient with swelling, bruising and possible nerve damage. The incidents are alleged to have taken place between 10 February and 17 November last year. Ms Chyzy has admitted nine counts of misconduct but denies elements of most of the claims.

Hi guys

Very useful infor.

Taken from dental juice

This page is a brief aide-memoire on the risks of using of bleach as a canal irrigant in endodontics. Every procedure invloves risks, and risk management is an important part of being a dental professional.If you don't manage the risk effectively, see what can happen here...http://news.bbc.co.uk/go/em/fr/-/1/hi/scotland/south_of_scotland/6336321.stm Bleach is used extensively in endodontics, usually as 1% to 3% Sodium Hypochlorite Soution. It is the gold standard irrigant for canal disinfection. The benefits of using it in a careful professional manner outweigh the risks. HOWEVER

Bleach is alkaline, and will burn the mucosa if spilt into the mouth.

If swallowed, it will burn the oesophagus.

If inhaled, it will burn the lungs (and chlorine gas may be released).

If splashed, it will burn the eyes and nostrils.

If injected through the apex of a tooth, it will destroy the peri-radicular tissues, often leading to massive oedema (swelling), tissue necrosis, and risk of serious infection.Dental professionals using bleach have to accept the extra personal responsibility this brings, by knowing how to manage a bleach accident, and by using a careful operating technique that minimises the risks. Correct use of bleach:

Protect patient's clothes with a waterproof covering.

Place an absorbent bib over the waterproof.

Ensure patient is wearing well-fitting safety spectacles. Do not let them wear their own glasses.

Rubber dam is mandatory, and should be sealed with Caulk

The Hypochlorite syringes must be clearly marked, and only 3/4 full.

The delivery needle must be side-venting.

The delivery needle should be bent 5 mm short of the working length, so it can not be introduced too far accidentally.

Bleach is further introduced into the apical region with a file - not with the syringe plunger.

Bleach is delivered very slowly, and aspirated by an assistant using a small bore aspirator tip. The tip is held distal to, and as close as possible to the access cavity. Bleach should not be delivered unless an assistant is present.

As an extra precaution, a pledget of cotton wool may be held distal to the tooth, to absorb an accidental minor leak.

Inform the patient of the procedure, and tell them to alert you if they can taste bleach.

Bleach must not be used in a tooth with a perforation.Immediate Management of an intra-oral bleach accident

Remove the dam frame as quickly as possible, and lay the dam to the side of the mouth.

Sit the patient up.

Have them rinse out copiously.

Have them drink and swallow lots of water.

If possible, discourage vomiting. This may re-burn the oesophagus (on the way up) if any has been swallowed, and increase the risk of inhalation.

Dress the access cavity as quickly as possible with cotton wool and temporary filling, to protect the canals from saliva while the accident is managed.Bleach in eyes

Irrigate copiously for 15 minutes with saline or water.

Consider involvement of patient's Medical Practitioner, or Emergency Services.Bleach injection through the apexManagement suggested by Hales JJ, CR, Everett AP, SH. Treatment protocol for the management of a sodium hypochlorite accident during endodontic therapy. Gen Dent 2001; 49(3):278–81.

This will become apparent very quickly due to rapid swelling, bruising, and severe burning pain.

There may be sudden copious bleeding from the canal.

Provide immediate pain relief by administering local anesthesia to the affected area.

Allow the drainage of the inflammatory exudate and dilute the NaOCl by irrigating the canal system with normal saline solution or water.

Reassure the patient and inform him or her of the cause and severity of the complications.

Reduce swelling by applying cold compresses in 15-minute intervals for the first 24 hours, followed by warm compresses thereafter.

Prescribe prophylactic antibiotics to prevent secondary infection.

In consultation with the patient's medical practitioner, consider prescribing acetaminophen-based narcotic analgesics to control pain, and steroid medication to control inflammatory reaction.

Set up regular recall appointments to monitor the patient’s recovery and complete the endodontic therapy upon resolution of the acute symptoms.SincerelyLyudmylaHuhleyhuhley2006@...