The May cover story (Gluskin AH, Lai G, Peters CI, Peters OA. The Double-Edged Sword
of Calcium Hydroxide in Endodontics: Precautions and Preventive Strategies for Extrusion
Injuries Into Neurovascular Anatomy.
JADA. 2020;151:317-326) was very timely and should be mandatory reading for all current
residents in endodontic programs throughout the country, as well as for all dental
students during their endodontics education. The authors are not exaggerating when
they describe life-changing situations for patients who sustain the injuries described
through inadvertent extrusion of calcium hydroxide into neurovascular anatomy. As
a chief executive officer who oversees the management of malpractice claims for the
professional liability insurance carrier of 85% of Utah dentists, I can vouch for
the concerns expressed by the authors throughout the article about the unfortunate
complications and ramifications calcium hydroxide extrusion for patients. In my experience
handling a malpractice claim where a patient sustained the injuries described, the
problems that exacerbated the complications included improper use of a tip not indicated
for the syringe system and the patient failing to follow up with the practitioner
and missing the 48- through 72-hour window where surgical intervention consisting
of lavage and curettage of the affected area of the inferior alveolar nerve could
have been performed. Dental educators should emphasize the neurotoxic potential of
calcium hydroxide and the need for caution and care in its use in endodontic therapy,
as well the need for additional radiographic information when endodontics is contemplated
for mandibular molars in close proximity to the inferior alveolar canal.
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