Disinfection of dentinal tubules with 2% Chlorhexidine gel, Calcium hydroxide and herbal intracanal medicaments against Enterococcus faecalis: An in-vitro study

Antimicrobial efficacy of 2% chlorhexidine gel, triphala, and Azadirachta indica as intracanal medicaments against Enterococcus faecalis: A randomized clinical trial

Context

Concerns about adverse reactions and the development of antibiotic resistance have prompted an alternative treatment strategy that utilizes traditional medicinal herbs.

Aim

This randomized control trial assessed the antimicrobial efficacy of 2% chlorhexidine (CHX) gel, Triphala, and Azadirachta indica as intracanal medicaments against Enterococcus faecalis.

Materials and Methods

Forty patients with nonvital teeth and single root canals were selected (n = 10). Following the initial access opening, the first microbial samples (S1) were collected using paper points. Second microbial samples (S2) were collected following the chemo-mechanical preparation and 1 week after introducing the intracanal medicaments. Group I: 2% CHX, Group II: A. indica, Group III: Triphala, and Group IV: Calcium hydroxide (Ca(OH)2). S1 and S2 samples were collected, and bacterial growth was observed using the colony-forming unit (CFU) count.

Statistical Analysis

Comparison of the difference in CFU count among four groups was performed using one-way ANOVA test (P < 0.05) followed by post hoc Tukey test.

Results

Reduction in CFU count postmedication S2 from S1 in each group was statistically significant. Percentage reduction in CFU count was highest in Triphala group followed by A. indica and 2% CHX group. Percentage reduction in CFU count was least in Ca(OH)2 group. The post hoc pairwise comparison of % reduction in CFU count among four groups showed that the percent reduction was highest in Triphala group.

Conclusion

Triphala has considerable antimicrobial efficacy against E. faecalis.

Effect of Curcuma longa (Turmeric), as an intra-canal medicament, on inter-appointment endodontic pain in patients with symptomatic irreversible pulpitis: A randomized controlled clinical trial

Inter-appointment pain (IAP) is a subtype of postoperative pain which occurs between endodontic appointments. It may begin within a few hours after the first appointment and may continue for several days. Apart from mechanical instrumentation and thorough irrigation, intracanal medicaments play a central role in the disinfection of root canals and thus decreasing IAP. The aim of this study was to evaluate the effect of Curcuma Longa as an intracanal medicament on IAP in patients with symptomatic irreversible pulpitis (SIP). One hundred healthy adult patients having SIP in one of their single-rooted maxillary or mandibular teeth participated in this randomized, parallel, single-blinded clinical trial. After thorough biomechanical preparation, the root canals were randomly medicated with one of the following medicaments, Control (no medicament), Calcium Hydroxide, triple antibiotic paste (TAP), and Curcuma Longa. The pain was recorded using Visual analog scale at 4 h, 24 h, and every day until the seventh day. Data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed-rank tests. No statistical difference in pain scores was observed between Calcium Hydroxide, TAP or Curcuma Longa groups. It can be concluded that Curcuma Longa, Calcium hydroxide, and TAP are equally effective in controlling IAP.

Effect of Different Irrigant Activation Techniques on the Penetration of Calcium Hydroxide, an Intracanal Medicament: An In Vitro Study

Background and objective The main goal of root canal treatment is to eliminate microorganisms from the canal and to prevent re-infection. To achieve these goals, instrumentation must be combined with adequate irrigation and the placement of intracanal medicament. This study aims to compare the effect of different irrigation activation techniques, i.e., passive ultrasonic irrigation (PUI), EndoActivator (EA), and conventional needle irrigation on the penetration of calcium hydroxide (CH), an intracanal medicament into dentinal tubules. Methodology A total of 60 single-rooted extracted human teeth were selected, which were de-coronated to standardize the root length of 12 mm. An access cavity was prepared, and biomechanical preparation was done. The samples were randomly assigned to three experimental groups: Group I received conventional needle irrigation, Group II underwent EA irrigation, and Group III was subjected to PUI. All the samples were filled with CH paste mixed with Rhodamine B dye, and the orifice openings were sealed with Cavit. The samples were stored in an incubator for 24 hours and were subsequently sectioned horizontally at the coronal, middle, and apical thirds using a hard tissue microtome. These were observed under a confocal laser scanning microscope to evaluate the depth of medicament penetration. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY). The Shapiro-Wilk test was employed to assess normality, while ANOVA and Tukey's post hoc analysis were utilized to determine significance. Results It was observed that the depth of penetration of CH into dentinal tubules was highest in Group III (PUI), followed by Group II (EA irrigation), with the least penetration observed in Group I (conventional needle irrigation). All the groups showed maximum penetration at the coronal third followed by the middle and apical third. Conclusions Passive ultrasonic irrigant activation resulted in more penetration of CH into the dentinal tubules followed by EA irrigant activation.

Direct and residual antimicrobial effect of 2% chlorhexidine gel, double antibiotic paste and chitosan- chlorhexidine nanoparticles as intracanal medicaments against Enterococcus faecalis and Candida albicans in primary molars: an in-vitro study

BACKGROUND

Thorough disinfection of root canals in primary molars may be complicated by the complex root canal morphology. This in-vitro study aimed to compare direct and residual antimicrobial effect of 2% chlorhexidine (CHX) gel, 500 mg/ml double antibiotic paste (DAP) and chitosan-chlorhexidine nanoparticles (CS-CHX NPs) as intracanal medicaments against Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans) in primary molars.

METHODS

Mesial roots of 63 mandibular second primary molars were infected with E. faecalis and C. albicans. Teeth were divided into 9 groups: Ia: (CS-CHX NPs), IIa: (CHX), IIIa: (DAP), IVa: chitosan nanoparticles (CSNPs) in which medicaments were placed for 3 days, groups Ib: (CS-CHX NPs), IIb: CHX, IIIb: (DAP), IVb: (CSNPs) in which medicaments were placed for 7 days, and Group V (control): teeth were infected, irrigated with saline, and sampled 3- and 7-days post-infection. Microbiological samples were obtained after infection, 3, and 7 days after medicament placement and 7 days after medicament removal for both time points. One-way ANOVA, Tukey's post hoc test and paired t-test were used at p < 0.05.

RESULTS

CS-CHX NPs had the highest anticandidal effect which was comparable to CHX and significantly higher than other medicaments (p < 0.001) at both time points. CS-CHX NPs had the highest effect against E. faecalis which was comparable to DAP and significantly higher than other medicaments (p < 0.001) at 3 days. All medicaments showed similar effect against E. faecalis after 7 days. The 7-days placement significantly increased the antimicrobial effect against both micro-organisms in all groups, except CS-CHX NPs which showed an insignificant increase. CS-CHX NPs showed the highest residual effect against both micro-organisms that increased with 7-days placement.

CONCLUSION

CSNPs and CHX combination showed a synergistic effect against both micro-organisms. CS-CHX NPs displayed a higher effect at a shorter period compared to other medicaments, yet its residual effect was higher with 7-days placement.

Anti-bacterial efficacy of Aloe vera against E. Faecalis in comparison to other intracanal medicaments: A systematic review and meta-analysis

Introduction

This review article aims to evaluate the antibacterial efficacy of Aloe vera against Enterococcus faecalis (E. faecalis) in comparison to other intracanal medicaments by assessing experimental in-vitro studies associated with the objective, many of which performed bacterial inoculation on extracted human teeth or directly on laboratory petri dishes.

Materials & Methods

Publications from 2012 to 2022 were retrieved from databases, including PubMed, Scopus, and Cochrane Library, and they were screened against our inclusion criteria, leading to the incorporation of 18 studies into the systematic review and nine into the meta-analysis. Colony-forming units (CFUs) in the Aloe vera group were compared with saline, sodium hypochlorite (NaOCl), chlorhexidine (CHX), and calcium hydroxide (CaOH) using a meta-analysis (Stata software version 16.0), and forest plots were computed to record the sample size, mean and standard deviation value of the outcome CFU, and 95% confidence intervals.

Results

This systematic review indicates that Aloe vera demonstrates bactericidal properties that are higher than or similar to those of saline and CaOH, but CHX, NaOCl, and propolis exhibited higher antibacterial properties against E. faecalis than Aloe vera. In a meta-analysis, Aloe vera showed a non-significantly lower CFU count than CaOH and saline (p > 0.05), while Aloe vera had a higher CFU count than CHX and NaOCl (p > 0.05).

Conclusion

In summary, Aloe vera exhibits antibacterial capabilities against E. faecalis that are superior or equal to those of saline and CaOH, respectively, while CHX and NaOCl showed greater antibacterial efficacy against E. faecalis than Aloe vera (PROSPERO registration no. CRD42022314790).

Evaluation of antibacterial effects of different intracanal medicaments on Enterococcus faecalis in primary teeth: An in vitro study

OBJECTIVES

Successful endodontic therapy is based on the reduction of infecting bacteria by cleaning, shaping, and disinfecting of the root canal system, thus the use of intracanal dressing is necessary for optimal success of root canal treatment. This study was designed to evaluate the effect of chitosan and propolis as intracanal medicaments against Enterococcus faecalis compared to calcium hydroxide in primary root canals.

MATERIAL AND METHODS

Ninety-six extracted primary second molars were collected. Teeth preparation was completed to size 30 K-file. They were randomly divided into four groups; (A): chitosan, (B): propolis, (C): calcium hydroxide, and (D): control group (saline). The tooth specimens were inoculated with E. faecalis. Then, tested materials were applied for all groups in accordance to the groups each tooth belonged to. Following this, the bacterial colonies were counted after 24 h, 72 h, and 1 week of applying dressing materials and incubation. Finally, one-way analysis of variance and Fisher's least significant difference tests were used for statistical comparisons between the groups at a significance level of .05.

RESULTS

No statistically significant difference was found between groups A, B, and C for both 24 h and a week (p ≥ .05). Yet, a statistical difference between groups A, B, C, and D after 72 h and 1 week were seen (p ≤ .05).

CONCLUSIONS

Chitosan and propolis medicaments were as effective as calcium hydroxide against E. faecalis in primary root canal treatment and might be considered as an alternative dressing material between treatment sessions.

Feasibility of the crude extracts of Amorphophallus paeoniifolius and Colocasia esculenta as intracanal medicaments in endodontic therapy in comparison to the 940 nm diode laser: An in vitro antimicrobial study

Background/purpose

The elimination and debridement of intracanal bacteria are credited with long-term effectiveness in endodontic therapy. This study aimed to compare the antimicrobial efficacies of Amorphophallus paeoniifolius (Suran), Colocasia esculenta (Aravi) crude extracts as intracanal medicaments with calcium hydroxide (CH), 2% chlorhexidine (CHX) gel, and 940 nm diode laser.

Materials and methods

Fifty-eight intact, single-root, extracted human mandibular premolar teeth were prepared. The samples were sterilized, transferred into microcentrifuge tubes, and inoculated with E. faecalis. The samples were placed in an incubator for three weeks to allow the biofilm to grow. Then the samples were randomly divided into five experimental groups (n = 10), disinfected with Suran, Aravi crude extracts, CH, 2% CHX gel, and a 940 nm diode laser. The negative control group (n = 4) and the positive control group (n = 4). Then the samples were observed under light and scanning electron microscopy to monitor the E. faecalis biofilm. The sampling method was carried out in paper point (intracanal) and Peeso bur (intradentinal). Later the number of colony-forming units was counted and analyzed.

Results

Colony-forming units were significantly reduced in the 2% CHX gel in both sampling methods, while Suran showed lower colony-forming units compared to Aravi and CH. The differences between experimental groups were not statistically significant (P > 0.05) in both sampling methods.

Conclusion

This study showed that the application of Suran and Aravi crude extracts as intracanal medicaments leads to a significant reduction in the number of bacterial colonies compared to CH, 2% CHX gel, and 940 nm diode laser.

Disinfection of dentinal tubules with diclofenac sodium and N-Acetylcysteine compared with calcium hydroxide as intracanal medicaments against Enterococcus faecalis

The purpose of this study was to evaluate the disinfection of dentinal tubules with diclofenac sodium (DS), N-acetylcysteine (NAC) and calcium hydroxide (CH). Contaminated dentinal blocks were divided into two control and seven experimental groups (n = 15): CH, DS, NAC, CH + 5% DS, 50% CH + 50% DS, CH + 5% NAC and 50% CH + 50% NAC. After seven days, dentine debris was obtained from two depths of 100 and 200 µm. The bacterial load was assessed by counting the number of colony-forming units (CFUs). Pure DS exhibited maximum antibacterial activity at both depths. At 200 µm, it showed statistically significant differences with all the other groups (P < 0.05). Mixing CH with either 5% or 50% of DS and NAC did not increase the antibacterial efficacy (P > 0.05). Pure DS was most effective in disinfecting dentinal tubules, and mixing CH with DS or NAC is not recommended.

Effectiveness of Honey in the Treatment and Prevention of Alveolar Osteitis: Systematic Review and Meta-analysis

Objectives

Honey has been used for millennia as a treatment for covering wounds that are difficult to repair. Hippocrates already reported the benefits of honey with this type of treatment. The objective of this work is to evaluate the literature on the use of honey in cases as preventive as treatment complications after extractions, more specifically alveolar osteitis or alveolitis.

Material and Methods

A systematic literature review was carried out on PubMed, LILACS and Dimensions platforms, following PRISMA guidelines, to gain more knowledge on the topic. Due to the scarcity of articles on the topic, there are no restrictions regarding languages, publication dates or impact factor journal. Animal studies and reviews were excluded. Risk of bias was assessed through Review Manager Software 5.4.

Results

With simple, low-cost, and affordable medications, many of the complications after tooth extractions can be resolved more quickly and less painfully for patients with more significant difficulties, whether financial or access, to other treatments.

Conclusion

Honey is an effective prevention and treatment for alveolar osteitis.

Nanoparticles in Endodontics Disinfection: State of the Art

Endodontic-related diseases constitute the fourth most expensive pathologies in industrialized countries. Specifically, endodontics is the part of dentistry focused on treating disorders of the dental pulp and its consequences. In order to treat these problems, especially endodontic infections, dental barriers and complex root canal anatomy should be overcome. This constitutes an unmet medical need since the rate of successful disinfection with the currently marketed drugs is around 85%. Therefore, nanoparticles constitute a suitable alternative in order to deliver active compounds effectively to the target site, increasing their therapeutic efficacy. Therefore, in the present review, an overview of dental anatomy and the barriers that should be overcome for effective disinfection will be summarized. In addition, the versatility of nanoparticles for drug delivery and their specific uses in dentistry are comprehensively discussed. Finally, the latest findings, potential applications and state of the art nanoparticles with special emphasis on biodegradable nanoparticles used for endodontic disinfection are also reviewed.

Comparative evaluation of antimicrobial efficacy of mushroom, Aloe vera, and Curcuma longa with calcium hydroxide as an intracanal medicament against Enterococcus faecalis: An in vitro study

Background:

The success of endodontic treatment mainly depends on the eradication of microorganisms from the root canal system. The use of intracanal medicaments plays a crucial role in eliminating resistant bacteria such as Enterococcus faecalis. Intracanal medicaments similar to herbal compounds can be used as a substitute for conventional calcium hydroxide (CaOH2) to prevent toxicity. The existing study aimed to compare and evaluate the antimicrobial activity of four different intracanal medicaments against E. faecalis.

Objectives:

The objective of this study is to compare and evaluate the antimicrobial efficacy of CaOH2, extracts of mushroom, aloe vera, and Curcuma longa as intracanal medicaments against E. faecalis.

Materials and Methods:

A total of 120 extracted human permanent premolars were decoronated, and chemomechanical preparation of the root canal was performed. After sterilization of the samples, pure cultures of E. faecalis were inoculated and incubated. Then, samples were separated randomly into five groups (n = 24). The antibacterial efficacy of the different intracanal medicaments was recorded at the end of days 1, 7, and 14 by determining the % reduction colony count. Data were statistically analyzed using a one-way analysis of variance, a Chi-square test for association, and a comparison of means using a t-test.

Results:

Curcuma longa exhibited an increased percentage reduction in colony counts compared to other herbal extracts against E. faecalis.

Conclusion:

Antibacterial action of the C. longa extract was uppermost followed by CaOH2, A. vera, and mushroom against E. faecalis.

Antibacterial Efficacy of Casein Phosphopeptide-Amorphous Calcium Phosphate Compared to Calcium Hydroxide as Intracanal Medicaments against Enterococcus faecalis: In-vitro Study

Background:

Endodontic infection may persist despite root canal instrumentation. Thus, the use of intracanal medicaments plays an essential role in eliminating resistant bacteria like Enterococcus faecalis, known to be associated with persistent infections in endodontically treated teeth. Although calcium hydroxide is the gold standard intracanal medicament, it has been reported that Enterococcus faecalis is immune to its effects. Therefore, several studies assessed the efficacy of other intracanal medicaments, but none to date evaluated Casein Phosphopeptide-Amorphous Calcium Phosphate.

Objectives:

This in-vitro randomized controlled study aimed to assess the antibacterial efficacy of Casein phosphopeptide-amorphous calcium phosphate as an intracanal medicament against Enterococcus faecalis and compared it to calcium hydroxide.

Methods:

60 extracted single root canal permanent teeth were prepared and later divided into three equal groups according to the intracanal medicament used. Group 1: No intracanal medicament (negative control), Group 2: Calcium hydroxide paste, and Group 3: Casein phosphopeptide-amorphous calcium phosphate paste. The intracanal medicaments were placed on the canals for 7 days. The outcome of this procedure was measured by counting colony-forming units. Statistical analysis was carried out using One-Way ANOVA and Tukey’s Post Hoc Test to determine significant differences between the groups.

Results:

The mean bacterial count for Group 2 was significantly lower than Group 1 and Group 3. Calcium hydroxide showed significantly more antibacterial efficacy against Enterococcus faecalis than Casein phosphopeptide-amorphous calcium phosphate and the negative control groups.

Conclusion:

Casein Phosphopeptide-amorphous calcium phosphate is ineffective in inhibiting Enterococcus faecalis growth compared to Calcium hydroxide.

Antibacterial Properties of Aloe vera on Intracanal Medicaments against Enterococcus faecalis Biofilm at Different Stages of Development

Background

Use of herbal compounds as an intracanal medicament in the field of endodontics has become noteworthy, one of which is the Aloe vera compound whose antibacterial effect has already been proven in the planktonic form of Enterococcus faecalis. The purpose of this study is to evaluate the antibacterial effect of Aloe vera on E. faecalis biofilms at the 4^th and 6^th week of development.

Materials and Methods

130 single root canal teeth without anomalies and caries were used. They were divided into two groups of 65 teeth for four and six weeks of biofilm production. Five samples of each group were examined for confirmation of biofilm formation under an electron microscope. Study groups were investigated with an antimicrobial agent as an intracanal medicament including 20 samples treated with Aloe vera, calcium hydroxide, and phosphate-buffered saline, and biofilm and survival of pathogens were investigated. Dentin chip suspensions were used for colony-forming unit (CFU) counting to estimate remaining E. faecalis counts.

Results

The CFU mean in the 4^th week subgroup in Aloe vera, phosphate-buffered saline, and calcium hydroxide was 0, 69166.66 ± 31688.58, and 25000 ± 30822.07, and in the 6^th week, it was 136.36 ± 323.33, 95000 ± 12247.44, and 27501.66 ± 36570.34, respectively, which showed a significant difference between the used materials (p < 0.05).

Conclusion

Aloe vera, in contrast to calcium hydroxide, eliminated 4^th and 6^th week biofilms and showed remarkable antibacterial properties against E. faecalis biofilm. These results support potency of Aloe vera to use as a natural antimicrobial material in the intracanal medicament.

Current herbal medicine as an alternative treatment in dentistry: In vitro, in vivo and clinical studies

Since the time that human population comprehended the importance of general health maintenance and the burden of disease, there has been a search for healing properties in the natural environment. Herbal medicine is the use of plants with medical properties for prevention and treatment of conditions that can affect general health. Recently, a growing interest has been observed toward the use of traditional herbal medicine alongside synthetic modern drugs. Around 80% of the population, especially in developing countries relies on it for healthcare. Oral healthcare is considered a major part of general health. According to the world health organization (WHO), oral health is considered an important part of general health and quality of life. The utilization of natural medications for the management of pathologic oro-dental conditions can be a logical alternative to pharmaceutical methods due to their availability, low costs, and lower side effects. The current literature review aimed at exploration of the variety and extent of herbal products application in oral health maintenance including different fields of oral healthcare such as dental caries, periodontal maintenance, microbial infections, oral cancers, and inflammatory conditions.

Evaluation of Antimicrobial Efficacy of Calcium Hydroxide along with Proton Pump Inhibitor against Enterococcus Faecalis

Aim:

The aim of this study was to evaluate in vitro the efficacy of pantoprazole, a proton pump inhibitor, alone, and in combination with calcium hydroxide against Enterococcus faecalis, a star survivor in endodontic pathology.

Materials and Methods:

Teeth were inoculated with E. faecalis strains MTCC 439 and were divided into groups. Group 1 used saline as the negative control, Group 2 used calcium hydroxide, Group 3 used pantoprazole alone, and Group 4 used calcium hydroxide along with pantoprazole. They were incubated and dentine harvesting was performed. Colonies were counted using a digital counting machine. Data were statistically analyzed.

Results:

Group 4 was found to be the most effective against the pathogen.

Discussion:

This study indicates that the association of calcium hydroxide with the proton pump inhibitor pantoprazole can be successfully used as an intracanal medicament against E. faecalis.

Assessment of Nitrofurantoin as an Experimental Intracanal Medicament in Endodontics

Background and Objectives. Multiple antibacterial agents have been mixed and used as an intracanal medicament-like modified triple antibiotic paste (MTAP) to eliminate Enterococcus faecalis (EF), which has been most frequently identified in the cases of failed root canal treatment and periapical lesions. This study is aimed at using a single antibacterial agent, nitrofurantoin (Nit), as an experimental intracanal medicament paste against different clinical isolates of EF), which has been most frequently identified in the cases of failed root canal treatment and periapical lesions. This study is aimed at using a single antibacterial agent, nitrofurantoin (Nit), as an experimental intracanal medicament paste against different clinical isolates of Materials and Methods. Three strains of EF), which has been most frequently identified in the cases of failed root canal treatment and periapical lesions. This study is aimed at using a single antibacterial agent, nitrofurantoin (Nit), as an experimental intracanal medicament paste against different clinical isolates of n = 90), group M (MTAP) (n = 90), group M (MTAP) (n = 90), group M (MTAP) (EF), which has been most frequently identified in the cases of failed root canal treatment and periapical lesions. This study is aimed at using a single antibacterial agent, nitrofurantoin (Nit), as an experimental intracanal medicament paste against different clinical isolates of n = 90), group M (MTAP) (n = 90), group M (MTAP) (n = 90), group M (MTAP) (EF), which has been most frequently identified in the cases of failed root canal treatment and periapical lesions. This study is aimed at using a single antibacterial agent, nitrofurantoin (Nit), as an experimental intracanal medicament paste against different clinical isolates of

Antibacterial efficacy of calcium hydroxide with iodoform versus calcium hydroxide with camphorated paramonochlorophenol as intrachannel pastes on an Enterococcus faecalis biofilm: A comparative in vitro study

Objective:

The objective of this study was to assess in vitro the antibacterial efficacy of Ca(OH)₂ with iodoform versus Ca(OH)₂ with camphorated paramonochlorophenol as intrachannel pastes on an Enterococcus faecalis biofilm.

Materials and Methods:

The diffusion method was used in wells. The strain used was E. faecalis ATCC 29212. Bile esculin agar was inoculated into 60-well plates of 5 mm in diameter. Three groups were formed: Group 1: Calen PMCC (Ca(OH)₂ + camphor paramonochlorophenol); Group 2: Metapex (Ca(OH)₂ + iodoform); and Group 3: camphor paramonochlorophenol inoculated with E. faecalis as a positive control. The plates were then incubated at 37°C for 24 h. Bacterial inhibition halos were read.

Results:

Group 1 presented the highest antimicrobial efficacy with a mean of 16.2 ± 0.6 mm, whereas Group 2 only had an antimicrobial effect of 9.7 ± 1.3 mm. Finally, Group 3 only exposed to the positive control (camphor paramonochlorophenol) showed an effect of 14.6 ± 1.0 mm. The inferential analysis showed statistically significant differences between the antimicrobial effect of the three groups (P = 0.001).

Conclusion:

Ca(OH)₂ paste with camphor paramonochlorophenol (Calen PMCC) has a greater antibacterial action on E. faecalis. The iodoform-associated Ca(OH)₂ paste (Metapex) showed significantly lower antibacterial action against E. faecalis (P < 0.05).