Hazards of Improper Dispensary: Literature Review and Report of an Accidental Chloroform Injection

Injection of sodium hypochlorite into soft tissues of the oral cavity: A literature review with clinical preventive recommendations

Injection of sodium hypochlorite (NaOCl) solution instead of local anaesthetic (LA) solution is an iatrogenic error with serious consequences including medico-legal implications. Such cases have been reported despite recommended precautionary measures. The purpose of this article is to review the literature on such cases and present clinical preventive recommendations. Electronic search was conducted in PubMed/Medline, Google Scholar, Cochrane, Scopus, Lilacs, ScienceDirect, and Crossref databases for articles reporting accidental or mistaken or inadvertent injection of NaOCl instead of LA during dental or endodontic treatment. Articles reporting NaOCl accident due to extrusion or injection of NaOCl beyond root confines were excluded. A total of 11 articles were found and reviewed. Data pertaining to the patient, injected NaOCl, cause, clinical manifestations, management, hospitalization, healing and recovery, and long-term or residual effects were extracted, compiled, and analysed for interpretation and discussion. Injection of NaOCl instead of LA into the soft tissues leads to varying clinical manifestations with unpredictable extent, outcome, and recovery period. The onus lies with the clinician to prevent it. Therefore, a clinician must take all the precautionary measures and confirm the identity of LA and NaOCl solutions before delivering them. The presented clinical recommendations assist clinicians to prevent it, including its potential medico-legal consequences. However, in case of such an unfortunate event, it is crucial to immediately identify and quickly manage it to limit the tissue damage or complications.

Cytotoxicity and genotoxicity evaluation of chloroform using Vicia faba roots

Chloroform is a widely used industrial chemical that can also pollute the environment. The aims of this study were to examine the potential cytotoxicity and genotoxicity of chloroform on plant cells, using the Vicia faba bioassay. Chloroform was evaluated at concentrations of 0.1, 0.5, 1, 2, and 5 mg·L-1. The following parameters were analyzed: the mitotic index (MI), micronucleus (MN) frequency, chromosomal aberration (CA) frequency, and malondialdehyde (MDA) content. The results showed that exposure to increasing concentrations of chloroform caused a decrease in MI and an increase in the frequency of MN in Vicia faba root tip cells, relative to their controls. Moreover, various types of CA, including C-mitosis, fragments, bridges, laggard chromosomes, and multipolar mitosis, were observed in the treated cells. The frequency of MN was positively correlated with the frequency of CA in exposure to 0.1-1 mg·L-1 chloroform. Furthermore, chloroform exposure induced membrane lipid peroxidation damage in the Vicia faba radicle, and a linear correlation was observed between the MDA content and the frequency of MN or CA. These findings indicated that chloroform exposure can result in oxidative stress, cytotoxicity, and genotoxicity in plant cells.

Overview of Analytical Methods for Evaluating Tinidazole

BACKGROUND

Tinidazole (TIN) has amoebicidal, giardicidal, antifungal, and antimicrobial activities. It is marketed in the form of tablets. Analytical methods to assess the quality of TIN-based products are essential for correct pharmacotherapy.

OBJECTIVE

The objective of this review is to show an overview of the existing analytical methods for evaluating TIN, according to the quality control (QC) analysis routine and green analytical chemistry (GAC).

RESULTS

Official compendia show a method for evaluating TIN in tablets by nonaqueous titration, which has limitations (materials on the mg scale using solvents considered not recommended and harmful). The literature shows some analytical methods for evaluating TIN, both physicochemical and microbiological. The most used physicochemical method is UV (41%), and second is HPLC (28%). Among the microbiological methods, agar diffusion and turbidimetric methods are equally divided. The most studied matrix is TIN tablets (73%), and the most used solvent is methanol.

CONCLUSIONS

The literature shows space for the development of analytical methods according to GAC for evaluating TIN, optimizing time, resources, and materials, reducing waste generation, and opting for less aggressive reagents, solvents, and diluents.

HIGHLIGHTS

This review shows the status of analytical methods, both physicochemical and microbiological, for the analysis of TIN in pharmaceutical matrix, in the context of routine analysis of the chemical-pharmaceutical industries and of GAC.

Management of iatrogenic chloroform mucosal burn in the palate: a case report

Chloroform is used widely in endodontic treatments for solving gutta-percha points, but it can have destructive effects if it comes in to contact with oral mucosa. This article presents a case of necrotic ulcer of palatal and buccal mucosa due to injudicious use of chloroform in endodontic treatment, which has caused severe destruction in maxilla. A conservative treatment method of repeated curettage and irrigation was used and although the lesion healed completely, it had major effects on the patient’s quality of life including loss of two teeth. It is important that dentist be aware of the devastating effects of imprudent application of various chemicals used in dentistry. The conservative treatment used for this case can be helpful option for similar cases.

Effect of Sonic Agitation of a Binary Mixture of Solvents on Filling Remnants Removal as an Alternative to Apical Enlargement-A Micro-CT Study

BACKGROUND

This work aimed to evaluate the efficacy of sonic agitation of a binary mixture of solvents (methyl ethyl ketone/tetrachloroethylene) on filling remnants removal and compare the effects of solvent agitation with the enlargement to the next instrument size.

METHODS

Twenty-four mandibular incisors were prepared with ProTaper Next (X1, X2) and obturated with the single-cone technique and AH Plus sealer. The teeth were retreated with ProTaper Universal Retreatment and ProTaper Next and divided into two groups (n = 12) according to the final instrument (X3 or X4). All canals were submitted to a supplementary procedure consisting of a mixture of solvents-methyl ethyl ketone/tetrachloroethylene, agitated with EndoActivator. The volume of filling remnants was assessed through micro-computed tomography in the apical 5 mm. Statistical analysis was performed with a significance level of 5%.

RESULTS

The supplementary procedure of agitation of the solvent mixture was beneficial in both groups (p < 0.05). There were no statistically significant differences between canals re-prepared until X4 and canals re-prepared until X3 plus solvent (p > 0.05).

CONCLUSIONS

An additional step with a two-solvent solution potentiated by EndoActivator showed to be very effective for the removal of gutta-percha and resinous sealer remnants from apical root canals of mandibular incisors, avoiding further enlargement.

ZnO Nanocrystal-Based Chloroform Detection: Density Functional Theory (DFT) Study

We investigated the detection of chloroform (CHCl3) using ZnO nanoclusters via density functional theory calculations. The effects of various concentrations of CHCl3, as well as the deposition of O atoms, on the adsorption over ZnO nanoclusters were analyzed via geometric optimizations. The calculated difference between the highest occupied molecular orbital and the lowest unoccupied molecular orbital for ZnO was 4.02 eV. The most stable adsorption characteristics were investigated with respect to the adsorption energy, frontier orbitals, elemental positions, and charge transfer. The results revealed that ZnO nanoclusters with a specific geometry and composition are promising candidates for chloroform-sensing applications.

Clarification of Stevia rebaudiana Bertoni extract by Ca based silica microspheres

Pre-treated Stevia rebaudiana Bertoni extract was clarified via using calcium (Ca) based silica (Si) microspheres. Both adsorption and chemical treatment were applied to extracts, and their effects on clarification were determined by comparison. The study aimed to maintain the highest level of clarity by eliminating chemicals from the treatment procedure. Although close in range with chemical treatment, the highest level of clarity was obtained in the presence of sole Ca/Si application. Clarification was achieved in an interval of 95-99 % with applied procedures. Sustainable utilization of Ca/Si microspheres was investigated by conducting three consecutive adsorption cycles with used microspheres. Results indicated minor changes in clarification levels at the end of three straight runs with used microspheres. Sustainable adsorption of impurities from the extract without the use of additional chemicals was the highlight of the present study.