Sir, a 50-year-old female presented on 29 November 2019 complaining of tenderness in her right cheek area, reduced sensation at the right corner of her lips and a dent in her cheek. It transpired that during second stage root canal treatment at 14 on 12 December 2018 a hypochlorite injury occurred. The notes of the treating dentist report that a radiograph revealed the working length to be too short and length was increased, and that on the final irrigation with hypochlorite the patient complained of pain. The procedure was stopped, the patient was asked to rinse with distilled water and the root canals were flushed with distilled water. The patient was informed of the incident and advised to take ibuprofen. When she left the surgery she was not in any pain. A radiograph did not show any evidence of lateral perforation or excessive apical preparation.

The patient contacted the practice later that day to say that the swelling had increased, she had called 111 and been advised to attend hospital whereupon she was given antibiotics and an appointment with an oral and maxillofacial surgeon who prescribed further antibiotics, and later, prednisolone. The patient was having difficulty with drooling due to reduced sensation, had a hard lump adjacent to 14 and an area of fat atrophy.

The soft tissue defect and area of reduced sensation one year following the hypochlorite injury are shown in Figure 1. The patient is considering surgery of fillers for the soft tissue defect.

Fig. 1
figure 1

The soft tissue defect and area of reduced sensation one year following hypochlorite injury

Full size image

Suggested strategies to reduce the damage of hypochlorite injuries include:1,2

  • Immediate and copious irrigation with saline or water for 15 minutes

  • Ice pack compression for 24 hours followed by warm compress for 24 hours

  • Analgesics to manage pain

  • Antibiotics to prevent secondary infection

  • Consideration of steroid therapy for severe injuries (with referral as required).