Effects of endodontic irrigants on blood and blood-stained dentin

Objectives: This study aimed to investigate bleaching effects of common endodontic irrigants on human whole blood and blood-stained dentin. Specifically, it was assessed whether sodium hypochlorite at a clinically recommended concentration (2.5% NaOCl) would bleach with similar efficacy as a peroxide-based irrigant at higher molarity (5% H2O2). Furthermore, the effects of a NaOCl-compatible chelator with a high affinity to iron (Dual Rinse HEDP) were investigated. Methods: Human whole blood was mixed at a 1:20 ratio with either phosphate-buffered saline, 9% HEDP, 2.5% NaOCl, 2.5% NaOCl containing 9% HEDP, or 5% H2O2. Effects were assessed spectrometrically and photographically. Human dentin specimens were prepared with a methacrylate reservoir for liquids and a polished assessment side over 1 mm dentin thickness. Dentin was stained using human whole blood for 3 weeks and subsequently exposed to the irrigants for 60 min. Measurements were performed in the CIELAB color space. Results were compared using parametric tests with the alpha-type error set to 5%. Results: When directly exposed, the solutions containing NaOCl completely discolored the blood, while the 5% H2O2 exerted a bleaching effect without complete dissolution of dissolved matter, and the pure 9% HEDP had no effect at all. The NaOCl solutions bleached blood-stained dentin more efficiently than H2O2 (p < 0.05). Conclusions: Under the current conditions, the 2.5% NaOCl solution had a stronger bleaching effect on blood and blood-stained dentin than 5% H2O2. HEDP did not have any direct impact on blood color or NaOCl-derived bleaching