Sodium hypochlorite is now used in endodontics during root canal treatments. It is the medicament of choice due to its efficacy against pathogenic organisms and pulp digestion. In previous times, Henry Drysdale Dakin’s solution (0.5%) had been used. Its concentration for use in endodontics today varies from 0.5% to 5.25%. At low concentrations it will dissolve mainly necrotic tissue; whereas at higher concentrations tissue dissolution is better but it also dissolves vital tissue, a generally undesirable effect. It has been shown that clinical effectiveness does not increase conclusively for concentrations higher than 1%
MECHANISM OF ACTION
Sodium hypochlorite is a strong oxidizer. Oxidation reactions are corrosive, solutions burn skin and cause eye damage, in particular, when used in concentrated forms. However, as recognized by the NFPA, only solutions containing more than 40% sodium hypochlorite by weight are considered hazardous oxidizers. Solutions less than 40% are classified as a moderate oxidizing hazard (NFPA 430, 2000).
Chlorination of drinking water can oxidize organic contaminants, producing trihalomethanes (also called haloforms), which are carcinogenic.
Household bleach and pool chlorinator solutions are typically stabilized by a significant concentration of lye (caustic soda, NaOH) as part of the manufacturing reaction. Skin contact will produce caustic irritation or burns due to defatting and saponification of skin oils and destruction of tissue. The slippery feel of bleach on skin is due to this process.
Sodium thiosulfate (thio) is an effective chlorine neutralizer. Rinsing with a 5 mg/L solution, followed by washing with soap and water, quickly removes chlorine odor from the hands.
Mixing bleach with some household cleaners can be hazardous. For example, mixing an acid cleaner with sodium hypochlorite bleach generates chlorine gas. Mixing with ammonia solutions (including urine) produces chloramines.
NH4OH + NaClO → NaOH + NH2Cl + H2O
Both chlorine gas and chloramine gas are toxic. Bleach can react violently with hydrogen peroxide and produce oxygen gas:[9]
H2O2(aq) + NaClO(aq) → NaCl(aq) + H2O(l) + O2(g)
It is estimated that there are about 3300 accidents needing hospital treatment caused by sodium hypochlorite solutions each year in British homes (RoSPA, 2002).
One major concern arising from sodium hypochlorite use is that it tends to form chlorinated organic compounds; this can occur during household storage and use as well during industrial use.[5] For example, when household bleach and wastewater were mixed, 1-2% of the available chlorine was observed to form organic compounds.[5] As of 1994, not all the byproducts had been identified, but identified compounds include chloroform and carbon tetrachloride.[5] The estimated exposure to these chemicals from use is estimated to be within occupational exposure limits.[5]
A recent European study indicated that sodium hypochlorite and organic chemicals (e.g., surfactants, fragrances) contained in several household cleaning products can react to generate chlorinated volatile organic compounds (VOCs).[10] These chlorinated compounds are emitted during cleaning applications, some of which are toxic and probable human carcinogens. The study showed that indoor air concentrations significantly increase (8-52 times for chloroform and 1-1170 times for carbon tetrachloride, respectively, above baseline quantities in the household) during the use of bleach containing products. The increase in chlorinated volatile organic compound concentrations was the lowest for plain bleach and the highest for the products in the form of “thick liquid and gel”. The significant increases observed in indoor air concentrations of several chlorinated VOCs (especially carbon tetrachloride and chloroform) indicate that the bleach use may be a source that could be important in terms of inhalation exposure to these compounds. While the authors suggested that using these cleaning products may significantly increase the cancer risk,[11] this conclusion appears to be hypothetical:
The highest level cited for concentration of carbon tetrachloride (seemingly of highest concern) is 459 micrograms per cubic meter, translating to 0.073 ppm (part per million), or 73 ppb (part per billion). The OSHA-allowable time-weighted average concentration over an eight-hour period is 10 ppm,[12] almost 140 times higher;
The OSHA highest allowable peak concentration (5-minute exposure for five minutes in a 4-hour period) is 200 ppm,[12] twice as high as the reported highest peak level (from the headspace of a bottle of a sample of bleach plus detergent).
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