Antibacterial activities of root canal sealers against selected anaerobic bacteria

Comparative Assessment of the Antimicrobial Efficacy of Triclosan, Amoxicillin and Eugenol against Enterococcus faecalis

Aims

Elimination of microorganisms and prevention of recurrence of infection from the complex root canal system of primary teeth requires an obturating material with broad antimicrobial activity. Hence, the purpose of the study is to assess and compare the antimicrobial efficacy of Triclosan, Amoxicillin and Eugenol individually and in combinations against a resistant microorganism viz., Enterococcus faecalis.

Materials and methods

A two-fold serial dilution method was used to check the minimum inhibitory concentration (MIC) of triclosan, amoxicillin and eugenol against thirty E. faecalis (isolated from oral lesions). The resistant strains were subjected to different combinations of three agents by modified checkerboard method. MIC was determined after incubation for 24 hours at 370°C. Then the three dilutions from MIC were inoculated on BHI agar plates and incubated overnight to determine minimum bactericidal concentration (MBC).

Results

The mean MIC and MBC of triclosan was 3.43 μg/mL and 3.75 μg/mL respectively. Whereas for amoxicillin, it was 3.43 μg/mL and 3.85 μg/mL. Eugenol did not show any inhibition up to a concentration of 3200 μg/mL. In combination, eugenol showed good synergistic effect with both triclosan and amoxicillin. In combination with triclosan, eugenol showed much promising result as compared with amoxicillin. But triclosan and amoxicillin combination showed inhibition at higher concentrations.

Conclusion

Triclosan and eugenol combination showed better effectiveness against E. faecalis in comparison to amoxicillin and eugenol. Triclosan and amoxicillin showed antagonism when used in combination against E. faecalis.

How to cite this article

Gowda J, Tavarageri A, Kulkarni R, et al. Comparative Assessment of the Antimicrobial Efficacy of Triclosan, Amoxicillin and Eugenol against Enterococcus faecalis. Int J Clin Pediatr Dent 2021;14(1):59-62.

In vitro antimicrobial effect of different root canal sealers against oral pathogens

Background and Purpose:

Root canal therapy is the primary method for the treatment of an infected pulp in modern dentistry. The main aim of endodontic treatment is the elimination of bacteria and their products from infected root canals. In this study, we attempted to investigate the antimicrobial activity of three root canal sealers against oral pathogens.

Materials and Methods:

The antimicrobial effectiveness of three endodontic sealers with different chemical compositions, namely resin (AH 26), zinc oxide eugenol (ZOE), and mineral trioxide aggregate (MTA), against Candida albicans, Streptococcus sanguis, Streptococcus salivarius, Streptococcus mutans, and Lactobacillus casei was assayed by agar well diffusion method (AWDM). The tested sealers were prepared according to the manufacturer’s instructions and poured in the prepared wells of agar plates; diluted inocula (10⁵ and 10⁶ CFU/ml) of the tested microorganism strains were also used. The minimum inhibitory concentration (MIC) values of the selected canal sealers ranged between 3.12 and 50 mg.ml^-1 against the employed microorganism strains. All the plates were incubated at 37°C under anaerobic condition for bacteria and at 30°C for C. albicans. After three days, the inhibition zones were measured.

Results:

In this investigation, AH 26 exhibited strong activity against C. albicans with the minimum inhibitory concentration of 12.5 mg.ml^-1, but ZOE and MTA did not act against C. albicans. ZOE sealer had the highest antimicrobial activity against the tested bacteria, while MTA showed the lowest antimicrobial activity.

Conclusion:

The ascending sequence of microbial growth inhibition zones was as follows AH 26 > ZOE > MTA.

In Vitro Antimicrobial Effectiveness of Root Canal Sealers against Enterococcus faecalis: A Systematic Review

INTRODUCTION

The purpose of this systematic review was to summarize the outcomes of in vitro studies of root canal sealers for their antimicrobial effectiveness against Enterococcus faecalis on the basis of direct contact test.

METHODS

An exhaustive literature search was performed by using MEDLINE, Scopus, TRIP, and OpenThesis databases, followed by an extensive hand search of references of identified articles. Two independent reviewers evaluated the studies for eligibility against inclusion and exclusion criteria and performed data abstraction and risk of bias evaluations.

RESULTS

A total of 31 articles were assessed for eligibility. Of these, 24 met the inclusion criteria and were included in the systematic review. A considerable heterogeneity was found in the methodologies of included studies. Therefore, it was not feasible to perform meta-analysis. Majority of the studies reported that different categories of freshly prepared sealers possessed some form of positive antimicrobial activity against E. faecalis for up to 24 hours. Antimicrobial efficacy was lost as the material set. Moderate evidence was found for no antimicrobial activity of aged (2-day to 7-day set) sealer samples across all categories.

CONCLUSIONS

The evidence indicated positive antimicrobial activity of freshly mixed sealers against E. faecalis. Antimicrobial efficacy was lost as the material set, with no bacterial growth inhibition by 2-day to 7-day set sealer samples. However, the studies included in this review presented medium to high risk of bias. This review identified the need for the development of standardized methods to evaluate antimicrobial activity of root canal sealers in in vitro studies.

Evaluation of the medicinal use of clay minerals as antibacterial agents

Natural clays have been used to heal skin infections since the earliest recorded history. Recently our attention was drawn to a clinical use of French green clay (rich in Fe-smectite) for healing Buruli ulcer, a necrotizing fasciitis ('flesh-eating' infection) caused by Mycobacterium ulcerans. These clays and others like them are interesting as they may reveal an antibacterial mechanism that could provide an inexpensive treatment for this and other skin infections, especially in global areas with limited hospitals and medical resources.Microbiological testing of two French green clays, and other clays used traditionally for healing, identified three samples that were effective at killing a broad-spectrum of human pathogens. A clear distinction must be made between 'healing clays' and those we have identified as antibacterial clays. The highly adsorptive properties of many clays may contribute to healing a variety of ailments, although they are not antibacterial. The antibacterial process displayed by the three identified clays is unknown. Therefore, we have investigated the mineralogical and chemical compositions of the antibacterial clays for comparison with non-antibacterial clays in an attempt to elucidate differences that may lead to identification of the antibacterial mechanism(s).The two French green clays used to treat Buruli ulcer, while similar in mineralogy, crystal size, and major element chemistry, have opposite effects on the bacterial populations tested. One clay deposit promoted bacterial growth whereas another killed the bacteria. The reasons for the difference in antibacterial properties thus far show that the bactericidal mechanism is not physical (e.g., an attraction between clay and bacteria), but by a chemical transfer or reaction. The chemical variables are still under investigation.Cation exchange experiments showed that the antibacterial component of the clay can be removed, implicating exchangeable cations in the antibacterial process. Furthermore, aqueous leachates of the antibacterial clays effectively kill the bacteria. Progressively heating the clay leads first to dehydration (200 degrees C), then dehydroxylation (550 degrees C or more), and finally to destruction of the clay mineral structure by (~900 degrees C). By identifying the elements lost after each heating step, and testing the bactericidal effect of the heated product, we eliminated many toxins from consideration (e.g., microbes, organic compounds, volatile elements) and identified several redox-sensitive refractory metals that are common among antibacterial clays. We conclude that the pH and oxidation state buffered by the clay mineral surfaces is key to controlling the solution chemistry and redox related reactions occurring at the bacterial cell wall.

In vitro evaluation of the antimicrobial activity of endodontic sealers

The purpose of this study is to evaluate the antimicrobial activity of the endodontic sealers: N-Rickert, Sealapex, AH Plus, Mineral Trioxide Aggregate (MTA) and portland cement. The Agar diffusion method was used in plates previously inoculated with the following microorganisms: C. albicans, S. aureus, E. faecalis, E. coli. The diameters of microbial inhibition zones were measured after 24 hours of incubation in kiln at 37°C. According to the methodology used, it was possible to conclude that only the sealers AH Plus and N-Rickert presented antimicrobial activity against C. albicans, S. aureus, and E. coli; no antimicrobial activity in MTA, Sealapex and portland cement was observed. N-Rickert presented the largest inhibition zones varying from 8 to 18 mm, and the microorganism E. faecalis was resistant against all sealers tested.

In vitro evaluation of the antimicrobial activity of five root canal sealers

The aim of the present study was to analyze the antimicrobial properties of five endodontic sealers: Endo Fill, Endomethasone, Endomethasone N, Sealer 26 and AH-Plus, against the following microorganisms: Candida albicans, Staphylococcus aureus, Enterococcus faecalis, Streptococcus sanguis and Actinomyces naeslundii. The sealers were tested immediately, 24 h, 48 h and 7 days after manipulation.The direct contact method through the observation of the microbial growth in liquid medium and the agar diffusion test were used to evaluate the antimicrobial properties of the sealers. The results, in both methodologies used, showed that immediately after manipulation, Endo-Fill and Endomethasone demonstrated the highest antimicrobial activity, with no statistically significant difference between them. Sealer 26 demonstrated the lowest antimicrobial activity. At all other times after manipulation, there were no statistically significant differences among all the sealers tested. In conclusion, none of the sealers totally inhibited the growth of the microorganisms. Furthermore, the antimicrobial activity of each sealer decreased with time and was dependent upon the microbial susceptibility to them.

Development of bacterial resistance to several biocides and effects on antibiotic susceptibility

The aims of this study were to investigate the development of bacterial resistance to eugenol, thymol, trichlorocarbanalide (TCC), didecyldimethylammonium chloride (DDDMAC) and C10-16-alkyldimethyl, N-oxides (ADMAO) and subsequent effects on antibiotic susceptibility. An agar minimum inhibitory concentration (MIC) method was used to assess the activity of the biocides against standard bacterial strains and laboratory mutants. A range of techniques including disk diffusion and gradient plate experiments were used to attempt to develop bacterial 'resistance' or tolerance to the biocides. The mutants produced were examined for cross-resistance to the other biocides and to antibiotics via disk diffusion and gradient plate MIC methods. Outer membrane proteins of the mutants were extracted and examined using sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Escherichia coli triclosan-resistant mutants were not cross-resistant to eugenol, thymol, TCC, DDDMAC and ADMAO. Mutants with elevated MICs to DDDMAC (E. coli and Pseudomonas aeruginosa), thymol (E. coli) and eugenol (E. coli) were isolated, but all remained sensitive to higher concentrations of the agents. Bacteria with elevated MICs to TCC and ADMAO were not obtained. Some low-level cross-resistance between DDDMAC, eugenol and thymol was observed with the E. coli gradient plate mutants, as well as reduced susceptibility to antibiotics, most notably chloramphenicol. The lack of cross-resistance of the triclosan mutants suggested that the mode of action of triclosan is not shared with the other biocides studied. SDS-PAGE results indicated that the DDDMAC P. aeruginosa mutant had a reduced amount (or absence) of one outer membrane protein in comparison with the standard strain. In conclusion, under laboratory conditions, bacterial exposure to thymol, eugenol and DDDMAC can lead to reduced susceptibility between selected biocidal agents and antibiotics, more specifically, chloramphenicol. However, further studies are required to determine if this is of clinical significance.

Activity of endodontic antibacterial agents against selected anaerobic bacteria

The antimicrobial activity of substances used as antibacterial agents (solutions of 10% calcium hydroxide, camphorated paramonochlorophenol - PMCC, 2% chlorhexidine digluconate and 10% castor oil plant detergent) on anaerobic bacteria (Fusobacterium nucleatum ATCC 25586, Prevotella nigrescens ATCC 33563, Clostridium perfringens ATCC 13124 and Bacteroidesfragilis ATCC 25285), using a broth dilution technique, was evaluated in vitro. For determination of minimum inhibitory and minimum bactericide concentrations (MIC and MBC), two culture broths, Reinforced Clostridial Medium (RCM) and supplemented Brucella, standardized inoculum and serially diluted solutions were used. All antibacterial agents presented antimicrobial activity that varied for different bacteria. There were no differences in the performance of the two broths. Chlorhexidine digluconate was the most effective, with the lowest MICs, followed by castor oil detergent, PMCC and calcium hydroxide. C. perfringens and B. fragilis were the most resistant bacteria to all agents.

Antimicrobial activity of Ca(OH)2 dental cements: an in vitro study

The effect of five commercial calcium hydroxide root canal medications (XR-SPAD, Calcicur, Hy-cal, Root-cal, Hypo-cal) and two calcium hydroxide mixtures (with water or glycerin) on the growth of (a) three anaerobic bacteria associated with endodontic infections; and (b) saliva bacterial strains was determined using the agar diffusion inhibitory test. Statistically significant zones of bacterial growth inhibition for all the bacteria tested were observed. Calcium hydroxide mixed with glycerin showed the largest zones of bacterial inhibition, whereas Root-cal was the least active. These results underline the necessity to evaluate the antibacterial potential of endodontic medications against the different bacterial strains commonly isolated from infected root canals.

Antimicrobial effect of six endodontic sealers: an in vitro evaluation

The aim of this study was to determine the in vitro antimicrobial effect of six endodontic sealers after 2, 20 and 40 days. The sealers studied were Apexit, Endion, AH26, AH-Plus. Procosol and Ketac Endo. The microorganisms used were Candida albicans, Staphylococcus aureus, Streptococcus mutans and Actinomyces israelii. Petri dishes were filled with sterile agar and 0.1-ml wells were prepared and filled with the sealers. The agar plates were stored for 24 h at 37 degrees C. The samples were then removed, immersed in 4.5 ml of culture medium and divided into three groups. The samples in group 1 were stored for 2 days at 37 degrees C whereas the samples of groups 2 and 3 were stored at 4 degrees C for 20 and 40 days respectively. The samples were then removed and discarded, and 0.1 ml of the culture medium was seeded on the agar plates in order to perform colony forming unit counts. Apexit, Endion and AH-Plus produced slight inhibition on Streptococcus mutans at 20 days and on Actinomyces israelii at every time interval. No effect was found on Candida albicans and Staphylococcus aureus. Ketac Endo only produced an antimicrobial effect on Actinomyces israelii at 2 and 40 days. AH26 and Procosol showed antimicrobial effect at 40 days on Candida albicans, at 20 and 40 days on Streptococcus mutans and Staphylococcus aureus, and an effective inhibition on Actinomyces israelii at every time interval. Statistical analysis revealed both sealers and microorganisms to be significant factors affecting results in groups 2 and 3. In conclusion, the sealers evaluated in this study showed different inhibitory effects depending on time span. Overall, sealers containing cugenol and formaldehyde proved to be most effective against the microorganisms at the time intervals studied.

Influence of different vehicles on the antibacterial effects of calcium hydroxide

This study evaluated the influence of three different vehicles on the antibacterial activity of calcium hydroxide against four bacterial species commonly found in endodontic infections. For this purpose, a broth dilution test using 24-well cell culture plates was performed. Results showed that all pastes were effective in killing the bacteria tested, but at different times. The calcium hydroxide/camphorated paramonochlorophenol/glycerin paste was the most effective against the four bacterial strains tested.

Dental materials: 1996 literature review

This critical review of the published literature on dental materials for the year 1996 has been compiled by the Dental Materials Panel of the UK. It continues the series of annual reviews started in 1973 and published in the Journal of Dentistry. Emphasis has been placed upon publications which report upon the materials science or clinical performance of the materials. The review has been divided by accepted materials classifications (fissure sealants, glass polyalkenoate cements, dentine bonding, dental amalgam, endodontic materials, casting alloys, resin-bonded bridges and ceramo-metallic restorations, ceramics, denture base resins and soft lining materials, impression materials, implants materials, orthodontic materials, biomechanics and image processing, resin composites and casting investment materials and waxes). Three hundred and thirteen articles have been reviewed.

Recontamination of coronally unsealed root canals medicated with camphorated paramonochlorophenol or calcium hydroxide pastes after saliva challenge

This in vitro study evaluated the ability of some medications to prevent recontamination of coronally unsealed root canals by bacteria from saliva. The medications tested were camphorated paramonochlorophenol (CPMC) applied in cotton pellets in the pulp chamber; calcium hydroxide/saline solution paste filling the root canal; and calcium hydroxide/CPMC/glycerin paste also filling the root canal. Medicated canals were exposed to saliva, and the number of days required for total recontamination to occur was recorded. Canals medicated with CPMC in cotton pellets were thoroughly recontaminated within an average of 6.9 days. Canals filled with calcium hydroxide/saline solution and calcium hydroxide/CPMC/glycerin showed entire recontamination within an average of 14.7 and 16.5 days, respectively. Calcium hydroxide pastes were significantly more effective than CPMC (p < 0.05).

Antibacterial activity of calcium hydroxide-containing endodontic sealers on Enterococcus faecalis in vitro

Antimicrobial activity of endodontic sealers is an important factor in the prognosis of root canal treatment. The aim of this study was to analyse the antimicrobial activity of calcium hydroxide-containing endodontic sealers, Sealapex (SA) and CRCS compared to a ZOE-containing sealer, Roth's cement. The sealers were mixed and placed on the side wall of microtitre plate wells. A 10 microL suspension of Enterococcus faecalis was added to the surface of the sealers 1 h, 24 h, or 7 days after mixture. Bacteria were allowed to come into contact with the sealers for 1 h at 37 degrees C. Fresh media was then added and bacterial growth was measured every 30 min for 16 h. The results showed that in 1-hour-old mixture, CRCS and Roth's cement had a significantly better antimicrobial effect than SA. In 24-hour-old mixtures, ZOE-based sealer showed a more potent antimicrobial activity than calcium hydroxide-containing sealers, whereas SA showed a significantly better antimicrobial effect in the 7-day-old mixture. The antimicrobial activity of each tested sealer changes differently with the time interval between mixing and testing, suggesting different physicochemical properties and potentially diverse clinical applications.

In vitro antibacterial activity of a glass ionomer endodontic sealer

The aim of this study was to evaluate the antibacterial activity of a recently introduced glass ionomer endodontic sealer, Ketac Endo (KE), compared to a commonly used ZOE-based endodontic sealer, Roth's cement (RC). With the use of E. faecalis as a test organism, the agar diffusion test (ADT) and direct contact test (DCT) were performed. For the DCT, the sealers were mixed and placed on the side wall of microtiter plate wells. A 10 microL bacterial suspension was placed on the tested material samples 20 min, 24 h, and 7 days after mixing. Bacteria were allowed to directly contact the sealers for 1 h at 37 degrees C. Fresh media was then added and bacterial growth was measured every 30 min over 15 h. The results showed that in the ADT, freshly mixed KE exhibited a twofold greater inhibition zone than RC (p < 0.05); in the DCT, freshly mixed KE and RC completely inhibited bacterial growth. The 24-h and 7-day samples of KE showed no antibacterial activity, whereas RC continued to exhibit a strong effect with similar samples. It has been concluded that KE possesses a short-acting very potent and diffusable antibacterial activity, whereas RC extends its effect over 7 days after setting.