Introduction: Aqueous sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics. It is highly effective at dissolving organic debris and disinfecting the root canal system due to the high pH. Extravasation of NaOCl into intra oral and extra oral tissues can lead to devastating outcomes leading to long term functional and aesthetic deficits. Currently no clear guidelines are available which has caused confusion among the dental and oral and maxillofacial surgical community how best to manage these patients.

Aims and objectives: Formulate a valid guideline to manage patients with NaOCl injury.

Methods: Following a literature review and considering our own experience we were able to formulate a guideline to manage patients NaOCl injury. The use of antibiotics and steroids, radiological investigations, 3D imaging and Coleman fat graft transfer to augment facial defects have all been considered and presented with clinical images. This guideline also considers the toxicological aspect of treatment.

Conclusion: NaOCl injury is well documented but currently no guideline exists for management of such injuries. This guideline provides information to optimise management of these patients.