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Al-Sadah AY, AlEraky DM, Abuohashish HM, Atmeh AR. Evaluation of the antimicrobial efficacy of different nonsteroidal anti-inflammatory drugs alone or in combination with calcium hydroxide intracanal medicament: an in vitro study. Odontology 2024; 112:826-838. [PMID: 38265514 DOI: 10.1007/s10266-023-00892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024]
Abstract
This study explored the antimicrobial effects of ketoprofen, piroxicam, and celecoxib alone or combined with calcium hydroxide (CH) against two strains of Enterococcus faecalis (E. faecalis) and assessed the influence of such combinations on the pH of CH. Minimum inhibitory concentrations (MICs) of the three tested NSAIDs were determined. Tested pastes were placed into wells punched in seeded agar plates and the bacterial inhibition zones were measured. Antibiofilm activity was assessed against 3 weeks of biofilm induced in bovine dentine blocks. The pH of the pastes was measured at four-time intervals. MIC values were 3.12, 25, and 25 mg/ml for ketoprofen, piroxicam, and celecoxib, respectively, and were similar for both bacterial strains except for celecoxib, which showed 8% growth at the highest tested concentration against vancomycin-resistant E. faecalis. Ketoprofen had the largest mean inhibition zone that was comparable to CH. None of the six tested pastes exhibited antibiofilm activity of a significant level in comparison to CH. A noticeable increase in the antibiofilm activity was found when 20% NSAIDs were added to CH while maintaining an alkaline pH. Ketoprofen was found to be the most effective among the tested NSAIDs. Although its effect was comparable to CH, adding ketoprofen at a ratio of 20% resulted in 50% higher antimicrobial action than CH alone. Accordingly, incorporating NSAIDs in inter-appointment dressing has the potential to utilize their anti-inflammatory, local analgesic, and antibacterial actions, which overcome the limitations of CH and improve the outcome of root canal treatment.
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Affiliation(s)
- Attika Y Al-Sadah
- Fellowship in Endodontic Program, Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, 31441, Dammam, Saudi Arabia.
| | - Doaa M AlEraky
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, 31441, Dammam, Saudi Arabia
- Department of Microbiology and Immunology, College of Medicine, Gulf Medical University (GMU), Ajman, United Arab Emirates
| | - Hatem M Abuohashish
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, 31441, Dammam, Saudi Arabia
| | - Amre R Atmeh
- Department of Restorative Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Mohamed AA, Fayyad DM, El-Telbany M, Mohamed DAA. Antibacterial biofilm efficacy of calcium hydroxide loaded on Gum Arabic nanocarrier: an in-vitro study. BMC Oral Health 2024; 24:215. [PMID: 38341565 PMCID: PMC10859034 DOI: 10.1186/s12903-024-03941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND An innovative intracanal medication formulation was introduced in the current study to improve the calcium hydroxide (Ca(OH)2) therapeutic capability against resistant Enterococcus faecalis (E. faecalis) biofilm. This in-vitro study aimed to prepare, characterize, and evaluate the antibacterial efficiency of Ca(OH)2 loaded on Gum Arabic (GA) nanocarrier (Ca(OH)2-GA NPs) and to compare this efficiency with conventional Ca(OH)2, Ca(OH)2 nanoparticles (NPs), GA, and GA NPs. MATERIALS AND METHODS The prepared nanoparticle formulations for the tested medications were characterized using Transmission Electron Microscope (TEM) and Fourier-Transform Infrared Spectroscopy (FTIR). 141 human mandibular premolars were selected, and their root canals were prepared. Twenty-one roots were then sectioned into 42 tooth slices. All prepared root canals (n = 120) and teeth slices (n = 42) were divided into six groups according to the intracanal medication used. E. faecalis was inoculated in the samples for 21 days to form biofilms, and then the corresponding medications were applied for 7 days. After medication application, the residual E. faecalis bacteria were assessed using CFU, Q-PCR, and SEM. Additionally, the effect of Ca(OH)2-GA NPs on E. faecalis biofilm genes (agg, ace, and efaA) was investigated using RT-PCR. Data were statistically analyzed at a 0.05 level of significance. RESULTS The synthesis of NPs was confirmed using TEM. The results of the FTIR proved that the Ca(OH)2 was successfully encapsulated in the GA NPs. Ca(OH)2-GA NPs caused a significant reduction in the E. faecalis biofilm gene expression when compared to the control (p < 0.001). There were significant differences in the E. faecalis CFU mean count and CT mean values between the tested groups (p < 0.001) except between the Ca(OH)2 and GA CFU mean count. Ca(OH)2-GA NPs showed the least statistical E. faecalis mean count among other groups. SEM observation showed that E. faecalis biofilm was diminished in all treatment groups, especially in the Ca(OH)2-GA NPS group when compared to the control group. CONCLUSIONS Ca(OH)2 and GA nanoparticles demonstrate superior anti-E. faecalis activity when compared to their conventional counterparts. Ca(OH)2-GA NPs showed the best antibacterial efficacy in treating E. faecalis biofilm. The tested NP formulations could be considered as promising intracanal medications.
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Affiliation(s)
- Alshafey Alsayed Mohamed
- Department of Endodontics, Faculty of Dentistry, Suez Canal University, 4.5 Ring Road, Ismailia, 41522, Egypt
| | - Dalia Mukhtar Fayyad
- Department of Endodontics, Faculty of Dentistry, Suez Canal University, 4.5 Ring Road, Ismailia, 41522, Egypt
| | - Mohamed El-Telbany
- Microbiology and Botany Department, Faculty of Science, Zagazig University, Zagazig, 44519, Egypt
- Department of Bioscience and Biotechnology, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka, 819-0395, Japan
| | - Dalia Abd-Allah Mohamed
- Department of Endodontics, Faculty of Dentistry, Suez Canal University, 4.5 Ring Road, Ismailia, 41522, Egypt.
- Department of Endodontics, Faculty of Dentistry, Sinai University, Kantara, Ismailia, Egypt.
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Elmsmari F, Delgado LM, Duran-Sindreu F, Pérez RA, García ML, Teulé Trull M, Afrashtehfar KI, González JA, Sánchez-López E. Novel strategies enhancing endodontic disinfection: Antibacterial biodegradable calcium hydroxide nanoparticles in an ex vivo model. Int J Pharm 2023; 648:123627. [PMID: 37984620 DOI: 10.1016/j.ijpharm.2023.123627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023]
Abstract
Due to the high failure rates associated to endodontic disinfection, this study aimed to investigate the antibacterial properties of poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) loaded with Ca(OH)2 for endodontic disinfection procedures. Ca(OH)2 NPs production and physicochemical characterization were carried out as well as multiple antibacterial tests using three bacterial strains and an ex vivo model of endodontic infection with extracted human teeth. Agar diffusion test and broth dilution determined the inhibition growth zones (n = 5) and the minimal inhibitory concentration (MIC, n = 5), respectively. Cell viability was assessed using Live/Dead staining with confocal microscopy (n = 5). Data was analysed using ANOVA followed by post-hoc analysis. After 24 h of incubation, Ca(OH)₂ NPs demonstrated a MIC of 10 µg/mL for Porphyromonas gingivalis (p < 0.001) and Enterococcus faecalis and 5 µg/mL for Fusobacterium nucleatum (p < 0.001). Although the agar diffusion test did not exhibit any inhibition area for Ca(OH)2 nor for Ca(OH)₂ NPs, this was probably due to the buffering effect of the agar medium. However, the antibacterial capacity was confirmed in an ex vivo model, where instrumentalized teeth were infected with Enterococcus Faecalis and treated after 28 days of culture. A significant reduction in bacterial metabolic activity was confirmed for Ca(OH)2 NPs (40 % reduction with a single dose) and confirmed by Live/Dead staining. In conclusion, Ca(OH)₂-loaded PLGA NPs present promising antibacterial efficacy for endodontic disinfection procedures.
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Affiliation(s)
- Firas Elmsmari
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, PO Box 346, United Arab Emirates; Department of Endodontics, Faculty of Dentistry, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain; Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, PO Box 346, United Arab Emirates
| | - Luis María Delgado
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08028 Barcelona, Spain
| | - Fernando Duran-Sindreu
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08028 Barcelona, Spain
| | - Román A Pérez
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08028 Barcelona, Spain
| | - Maria Luisa García
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN(2)UB), University of Barcelona, 08028 Barcelona, Spain; Networking Research Centre of Neurodegenerative Disease (CIBERNED), Instituto de Salud Juan Carlos III, 28029 Madrid, Spain
| | - Míriam Teulé Trull
- Department of Endodontics, Faculty of Dentistry, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
| | - Kelvin I Afrashtehfar
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, PO Box 346, United Arab Emirates; Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland; Artificial Intelligence Research Center (AIRC), Ajman University, Ajman PO Box 346, United Arab Emirates.
| | - José Antonio González
- Department of Endodontics, Faculty of Dentistry, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain.
| | - Elena Sánchez-López
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN(2)UB), University of Barcelona, 08028 Barcelona, Spain; Networking Research Centre of Neurodegenerative Disease (CIBERNED), Instituto de Salud Juan Carlos III, 28029 Madrid, Spain; Unit of Synthesis and Biomedical Applications of Peptides, IQAC-CSIC, 08034 Barcelona, Spain.
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Anija R, Kalita C, Bhuyan AC, Hussain MDI, Saikia A, Das L. Comparative evaluation of the concentration-dependent effect of proton-pump inhibitor in association with calcium hydroxide and chlorhexidine on Enterococcus faecalis: An in vitro study. J Oral Maxillofac Pathol 2021; 25:198. [PMID: 34349438 PMCID: PMC8272501 DOI: 10.4103/jomfp.jomfp_303_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/23/2020] [Accepted: 01/19/2021] [Indexed: 11/04/2022] Open
Abstract
Background Enterococcus faecalis is the most persistent organism in the root canal which resists most of the intracanal medicaments. There is always a constant attempt to eliminate this endodontic pathogen from the root canal system. Aim The aim of this study was to evaluate the efficacy of the association of different concentrations of proton-pump inhibitor (PPI) (Lansoprazole) with calcium hydroxide (CH) and chlorhexidine (CHX) against E. faecalis using a broth dilution method. Materials and Methods E. faecalis was inoculated into brain-heart infusion broth at 37°C for 5 h. The master broth was then treated with CH (Group 1); CH + 2% CHX (Group 2); CH + PPI 6.25 μg/ml (Group 3A); CH + PPI 25 μg/ml (Group 3B); 2% CHX + PPI 6.25 μg/ml (Group 4A); 2% CHX + PPI 25 μg/ml (Group 4B); CH + 2% CHX + PPI 6.25 μg/ml (Group 5A), and CH + 2% CHX + PPI 25 μg/ml (Group 5B). The groups were spectrophotometrically analyzed at 630 nm at 24 h to determine the group with the least optical density. Statistical Analysis Comparison between the groups was done by the one-way analysis of variance and Kruskal-Wallis test for multiple comparisons. Results The mean percentage inhibition of E. faecalis by Group 5A (CH + 2% CHX + PPI 6.25 μg/ml) was the highest compared to other groups. The lowest mean value was observed in Group 3A (CH + PPI 6.25 μg/ml) indicating least efficiency. Conclusion There was a concentration-dependent effect of PPI on CH and CHX against E. faecalis. The maximum efficacy was found when the lower concentration of PPI was associated with CH/CHX mixture.
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Affiliation(s)
- R Anija
- Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India
| | - Chandana Kalita
- Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India
| | - A C Bhuyan
- Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India
| | - M D Iftikar Hussain
- Department of Animal Biotechnology, College of Veterinary Science, Guwahati, Assam, India
| | - Anindita Saikia
- Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India
| | - Lima Das
- Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India
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Karataş E, Uluköylü E, Albayrak M, Bayır Y. Effect of calcium hydroxide alone or in combination with ibuprofen and ciprofloxacin on postoperative pain and periapical prostaglandin E2 level: A randomized clinical study. Prostaglandins Other Lipid Mediat 2021; 153:106525. [PMID: 33383182 DOI: 10.1016/j.prostaglandins.2020.106525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 10/06/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
AIM The aim of the present study was to compare pure Ca(OH)2, Ca(OH)2 + ibuprofen and Ca(OH)2 + ciprofloxacin in terms of postoperative pain and prostaglandin E2 (PGE2) level in previously treated teeth with periapical lesions. MATERIALS AND METHODS Sixty-six patients were randomly assigned into 3 groups according to the intracanal medication (Ca(OH)2, Ca(OH)2 + ibuprofen and Ca(OH)2 + ciprofloxacin). After removing gutta-percha from the root canals, the PGE2 sample collection was obtained by introducing three sterile paper points into the root canals through the root apex (2 mm). Selected intracanal medicament was placed into the root canal and the participants were told to record postoperative pain levels at 24, 48, and 72 h and on 1 week after treatment using visual analog scale (VAS). At the second appointment, the medicaments were removed and second sampling was performed using the same method. The PGE2 levels measured by enzyme-linked immunosorbent assay kits, and the data were statistically analyzed. RESULTS All the tested Ca(OH)2 pastes were found to be significantly effective in lowering the preoperative PGE2 levels. However, intergroup analyses revealed that the Ca(OH)2 + ciprofloxacin group had the highest effectiveness in lowering PGE2 with a significant difference when compared with the pure Ca(OH)2 group. There was no statistically significant difference among the groups in terms of pre- and post-operative pain levels. CONCLUSION The Ca(OH)2 + ciprofloxacin medication is more effective than the pure Ca(OH)2 medication in lowering periapical PGE2 level. However, addition of ibuprofen or ciprofloxacin to the Ca(OH)2 paste does not provide extra benefit in terms of post-operative pain relief.
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Affiliation(s)
- Ertuğrul Karataş
- Department of Endodontics, Faculty of Dentistry, Atatürk University, Erzurum, Turkey.
| | - Esra Uluköylü
- Department of Endodontics, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - Mevlüt Albayrak
- Erzurum High Vocational School of Health, Ataturk University, Erzurum, Turkey
| | - Yasin Bayır
- Department of Biochemistry, Faculty of Pharmacy Ataturk University, Erzurum, Turkey
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Chandki R, Nikhil V, Kalyan SS. Comparative evaluation of substantivity of two biguanides - 0.2% polyhexanide and 2% chlorhexidine on human dentin. J Conserv Dent 2020; 23:46-50. [PMID: 33223641 PMCID: PMC7657421 DOI: 10.4103/jcd.jcd_256_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/07/2020] [Accepted: 08/04/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Substantivity is one of the desirable characteristics of root canal irrigants. Among conventional endodontic irrigants, only chlorhexidine (CHX) is known to exert significant substantivity on root canal dentin. This study explored the substantivity activity of a polymeric biguanide-poly hexamethylene biguanide (PHMB). Aim: The aim of this study was to determine the substantivity of a polymeric biguanide - 0.2% PHMB and compare it with that of 2% CHX. Materials and Methods: To evaluate and compare the substantivity of 0.2% PHMB and 2% CHX on root canal dentin, dentin disks were prepared and substantivity after 1 h, 24 h, 7 days and 21 days was measured using spectrophotometry. Statistical Analysis Used: The data so obtained were analyzed, and the intergroup comparison was made using unpaired t-test. Results: The results of this study indicated that 0.2%. PHMB exerts significantly greater substantivity than 2% CHX on human dentin. Conclusion: Within the limitations, this study supports the use of 0.2% polyhexanide as an endodontic irrigant based on its property of substantivity.
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Affiliation(s)
- Rita Chandki
- Swami Vivekanand Subharti University, Meerut, Uttarpradesh, India
| | - Vineeta Nikhil
- Department of Conservative Dentistry and Endodontics, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - S Sai Kalyan
- Department of Conservative Dentistry and Endodontics, Rural Dental College, Loni, Maharashtra, India
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Punathil S, Moyin S, Bhat SS, Hedge S, Pai A, James J. Comparison of Antibacterial Effect of Calcium Hydroxide Combined With Chlorhexidine and Povidone-Iodine Against Enterococcus faecalis in Dentinal Tubules of Human Incisors: An In Vitro Comparative Study. J Pharm Bioallied Sci 2020; 12:S448-S452. [PMID: 33149504 PMCID: PMC7595516 DOI: 10.4103/jpbs.jpbs_134_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: It has been found that the microorganism behind the failure of root-filled teeth is Enterococcus faecalis, which shows resistance to most of the intra-canal medicaments. Therefore, the purpose of this study was to evaluate the antibacterial efficacy of three intra-canal medications—calcium hydroxide with saline, combinations of calcium hydroxide with 2% chlorhexidine (CHX), and calcium hydroxide with 5% povidone-iodine—against E. faecalis in dentinal tubules of human incisors. Materials and Methods: Forty permanent maxillary central incisors were made into standardized segments and infected with E. faecalis. They were treated with a paste made of calcium hydroxide and 2% CHX, calcium hydroxide and 5% povidone-iodine, and calcium hydroxide and saline for 1 week. Dentinal shavings collected from the canal were suspended in thioglycollate broth solution and spread on brain heart infusion agar. Colony-forming units (CFUs) were enumerated and the CFU per milligram of dentin was calculated. The pH of the medicaments used was measured with the help of pH meter. Results: The results showed that the paste made from calcium hydroxide and 2% CHX was significantly more effective than that made from calcium hydroxide and povidone-iodine, and calcium hydroxide and saline. The addition of CHX or povidone-iodine did not affect the alkalinity of calcium hydroxide. Conclusion: This study concludes that Ca(OH)2 + 2% CHX are effective against E. faecalis. Combinations of calcium hydroxide and 5% povidone-iodine showed better antibacterial effect than calcium hydroxide and saline. Ca(OH)2 + saline was ineffective against E. faecalis.
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Affiliation(s)
- Sameer Punathil
- Department of Pediatric and Preventive Dentistry, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Shabna Moyin
- Department of Conservative Dentistry and Endodontics, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Sham S Bhat
- Department of Pediatric and Preventive Dentistry, Yenepoya Dental College, Mangalore, Karnataka, India
| | - Sundeep Hedge
- Department of Pediatric and Preventive Dentistry, Yenepoya Dental College, Mangalore, Karnataka, India
| | - Archana Pai
- Department of Pediatric and Preventive Dentistry, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Jeswin James
- Department of Pediatric and Preventive Dentistry, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
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Lima TFR, Ascendino JF, Cavalcante IDO, D Assunção FLC, Salazar-Silva JR, Silva EJNLD, Lemos SG, Soares ADJ. Influence of chlorhexidine and zinc oxide in calcium hydroxide pastes on pH changes in external root surface. Braz Oral Res 2019; 33:e005. [PMID: 30758405 DOI: 10.1590/1807-3107bor-2019.vol33.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/08/2018] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to assess the influence of chlorhexidine (liquid and gel) and zinc oxide in calcium hydroxide (CH) pastes on root pH in simulated external resorption. One hundred human anterior teeth with a single root canal were selected. After decoronation and root canal instrumentation, the specimens were divided into 4 experimental groups and 1 control group (without intracanal paste): CH + saline (CH+S), CH + 2% chlorhexidine liquid (CH+ CHX), CH + 2% chlorhexidine gel (CH+ CHXg), and CH + 2% chlorhexidine gel + zinc oxide (CH+ CHXg+ZnO). pH was measured using a microelectrode at 3 and 24 h, and 1, 2, 3, and 4 weeks after inserting intracanal pastes. Data were analyzed statistically using an ANOVA and Tukey's test (p < 0.05). The CH+CHXg+ZnO group had the highest pH values throughout (p<0.05). The CH+S and CH+ CHX groups had the highest pH values after 1 week and the CH+ CHXg group after 2 weeks. CH+ CHXg maintained the highest pH until the fourth week compared with CH+ CHX (p < 0.05). The control group remained at a neutral pH at all evaluated times. It can be concluded that chlorhexidine solution or gel maintained the alkaline pH of CH, and chlorhexidine gel allowed a slower decrease in pH over time. CH+ CHXg+ZnO showed the highest pH values and was an effective intracanal medication for maintaining alkaline root pH in the area of resorption.
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Affiliation(s)
- Thiago Farias Rocha Lima
- Universidade Federal da Paraiba - UFPB, Endodontics Area, Department of Restorative Dentistry, João Pessoa, PB, Brazil
| | | | | | - Fabio Luiz Cunha D Assunção
- Universidade Federal da Paraiba - UFPB, Endodontics Area, Department of Restorative Dentistry, João Pessoa, PB, Brazil
| | - Juan Ramon Salazar-Silva
- Universidade Federal da Paraiba - UFPB, Endodontics Area, Department of Restorative Dentistry, João Pessoa, PB, Brazil
| | | | | | - Adriana de Jesus Soares
- Universidade Estadual de Campinas - Unicamp, School of Dentistry of Piracicaba, Department of Restorative Dentistry, Piracicaba, SP, Brazil
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9
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Cardelle-Cobas A, Reis PJM, Costa E, Tavaria FK, Pintado ME. Chitosan impregnated gutta-percha points: antimicrobial in vitro evaluation and mechanical properties. INT J POLYM MATER PO 2018. [DOI: 10.1080/00914037.2018.1466134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alejandra Cardelle-Cobas
- Universidade Católica Portuguesa, Centro de Biotecnologia e Química Fina – Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Patrícia J. M. Reis
- Universidade Católica Portuguesa, Centro de Biotecnologia e Química Fina – Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Eduardo Costa
- Universidade Católica Portuguesa, Centro de Biotecnologia e Química Fina – Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Freni K. Tavaria
- Universidade Católica Portuguesa, Centro de Biotecnologia e Química Fina – Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Manuela E. Pintado
- Universidade Católica Portuguesa, Centro de Biotecnologia e Química Fina – Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
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10
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Saatchi M, Shokraneh A, Navaei H, Maracy MR, Shojaei H. Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis. J Appl Oral Sci 2015; 22:356-65. [PMID: 25466470 PMCID: PMC4245746 DOI: 10.1590/1678-775720140032] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/15/2014] [Indexed: 11/22/2022] Open
Abstract
Objective Enterococcus faecalis (E. faecalis) is the most
frequently isolated strain in failed endodontic therapy cases since it is
resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine
(CHX) is more effective than CH alone against E. faecalis is a matter of
controversy. Thus, the aim of this study was to conduct a systematic review and
meta-analysis of the literature. Material and Methods A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO,
and BBO databases, Clinical trials registers, Open Grey, and conference
proceedings from the earliest available date to February 1, 2013 was carried out
and the relevant articles were identified by two independent reviewers. Backward
and forward search was performed and then inclusion and exclusion criteria were
applied. The included studies were divided into "comparisons" according to the
depth of sampling and dressing period of each medicament. Meta-analysis was
performed using Stata software 10.0. The level of significance was set at
0.05. Results Eighty-five studies were retrieved from databases and backward/forward searches.
Fortyfive studies were considered as relevant (5 in vivo, 18
in vitro, 18 ex vivo, and 4 review articles).
Nine studies were included for meta-analysis. Inter-observer agreement (Cohen
kappa) was 0.93. The included studies were divided into 21 comparisons for
meta-analysis. Chi-square test showed the comparisons were heterogeneous
(p<0.001). Random effect model demonstrated no significant difference between
CH/CHX mixture and CH alone in their effect on E. faecalis
(p=0.115). Conclusions According to the evidence available now, mixing CH with CHX does not significantly
increase the antimicrobial activity of CH against E. faecalis. It
appears that mixing CH with CHX does not improve its ex vivo
antibacterial property as an intracanal medicament against E.
faecalis. Further in vivo studies are necessary to
confirm and correlate the findings of this study with the clinical outcomes.
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Affiliation(s)
- Masoud Saatchi
- Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Shokraneh
- Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hooman Navaei
- Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hasan Shojaei
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim D, Kim E. Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part I. In vitro studies. Restor Dent Endod 2014; 39:241-52. [PMID: 25383341 PMCID: PMC4223092 DOI: 10.5395/rde.2014.39.4.241] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/14/2014] [Indexed: 11/11/2022] Open
Abstract
The goal of endodontic treatment is the prevention and control of pulpal and periradicular infections. Calcium hydroxide (Ca(OH)2) has been widely used in endodontics as an intracanal medicament to eliminate the remaining microorganisms after chemomechanical preparation. The purpose of this article is to review the antimicrobial properties of Ca(OH)2 as an intracanal medicament in root canal treatment. The first part of this review details the characteristics of Ca(OH)2 and summarizes the results of in vitro studies related to its antimicrobial effect. The antimicrobial effect of Ca(OH)2 results from the release of hydroxyl ions when it comes into contact with aqueous fluids. Ca(OH)2 has a wide range of antimicrobial effects against common endodontic pathogens, but is less effective against Enterococcus faecalis and Candida albicans. The addition of vehicles or other agents might contribute to the antimicrobial effect of Ca(OH)2.
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Affiliation(s)
- Dohyun Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
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12
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Gomes BP, Vianna ME, Zaia AA, Almeida JFA, Souza-Filho FJ, Ferraz CCR. Chlorhexidine in Endodontics. Braz Dent J 2013; 24:89-102. [DOI: 10.1590/0103-6440201302188] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/02/2013] [Indexed: 11/21/2022] Open
Abstract
Chemical auxiliary substances (CAS) are essential for a successful disinfection and cleanness of the root canals, being used during the instrumentation and if necessary, as antimicrobial intracanal medicaments. Different CAS have been proposed and used, among which sodium hypochlorite (NaOCl), chlorhexidine (CHX), 17% EDTA, citric acid, MTAD and 37% phosphoric acid solution. CHX has been used in Endodontics as an irrigating substance or intracanal medicament, as it possesses a wide range of antimicrobial activity, substantivity (residual antimicrobial activity), lower cytotoxicity than NaOCl whilst demonstrating efficient clinical performance, lubricating properties, rheological action (present in the gel presentation, keeping the debris in suspension); it inhibits metalloproteinase, is chemically stable, does not stain cloths, it is odorless, water soluble, among other properties. CHX has been recommended as an alternative to NaOCl, especially in cases of open apex, root resorption, foramen enlargement and root perforation, due to its biocompatibility, or in cases of allergy related to bleaching solutions. The aim of this paper is to review CHX's general use in the medical field and in dentistry; its chemical structure, presentation form and storage; mechanism of action; antimicrobial activity including substantivity, effects on biofilms and endotoxins, effects on coronal and apical microbial microleakage; tissue dissolution ability; interaction with endodontic irrigants; effects on dentin bonding, metalloproteinases and collagen fibrils; its use as intracanal medicament and diffusion into the dentinal tubules; its use as disinfectant agent of obturation cones; other uses in the endodontic therapy; and possible adverse effects, cytotoxicity and genotoxicity.
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Sinha N, Patil S, Dodwad PK, Patil AC, Singh B. Evaluation of antimicrobial efficacy of calcium hydroxide paste, chlorhexidine gel, and a combination of both as intracanal medicament: An in vivo comparative study. J Conserv Dent 2013; 16:65-70. [PMID: 23349580 PMCID: PMC3548350 DOI: 10.4103/0972-0707.105302] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/10/2012] [Accepted: 09/27/2012] [Indexed: 12/01/2022] Open
Abstract
Aim: To compare the antimicrobial efficacy of calcium hydroxide (CH), 2% chlorhexidine gel (CHX) and a combination of both, on obligate anaerobes, facultative anaerobes and Candida spp . Materials and Methods: 90 single rooted permanent teeth were included in the study. After complete disinfection and access opening, the first microbiological pre-treatment sample (S1) was collected. After completion of instrumentation, a post-instumentation sample (S2) was taken and the teeth were divided into three groups: Group I: CH, Group II: 2% CHX, Group III: 2% CHX with CH. After 1 week, a post-medication sample (S3) was collected. Results: All three medicaments were effective in the elimination of obligate anaerobes. CHX and combination showed higher antimicrobial effect against facultative anaerobes and Candida spp. in comparison with CH. But there was no statistical significant difference between Group II and Group III. Conclusion: CHX with or without CH was more effective than CH alone against all the tested micro-organisms.
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Affiliation(s)
- Nidhi Sinha
- Department of Conservative Dentistry and Endodontics, Jodhpur Dental College, Jodhpur National University, Jodhpur, India
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14
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Paiva SSM, Siqueira JF, Rôças IN, Carmo FL, Leite DCA, Ferreira DC, Rachid CTC, Rosado AS. Clinical antimicrobial efficacy of NiTi rotary instrumentation with NaOCl irrigation, final rinse with chlorhexidine and interappointment medication: a molecular study. Int Endod J 2012; 46:225-33. [DOI: 10.1111/j.1365-2591.2012.02111.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 07/05/2012] [Indexed: 12/01/2022]
Affiliation(s)
- S. S. M. Paiva
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - J. F. Siqueira
- Department of Endodontics and Molecular Microbiology Laboratory; Estácio de Sá University Rio de Janeiro; Brazil
| | - I. N. Rôças
- Department of Endodontics and Molecular Microbiology Laboratory; Estácio de Sá University Rio de Janeiro; Brazil
| | - F. L. Carmo
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - D. C. A. Leite
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - D. C. Ferreira
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - C. T. C. Rachid
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - A. S. Rosado
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
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15
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Ito IY, Junior FM, Paula-Silva FWG, Da Silva LAB, Leonardo MR, Nelson-Filho P. Microbial culture and checkerboard DNA-DNA hybridization assessment of bacteria in root canals of primary teeth pre- and post-endodontic therapy with a calcium hydroxide/chlorhexidine paste. Int J Paediatr Dent 2011; 21:353-60. [PMID: 21481034 DOI: 10.1111/j.1365-263x.2011.01131.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate the root canal microbiota of primary teeth with apical periodontitis and the in vivo antimicrobial effects of a calcium hydroxide/chlorhexidine paste used as root canal dressing. DESIGN Baseline samples were collected from 30 root canals of primary teeth with apical periodontitis. Then, the root canals were filled with a calcium hydroxide paste containing 1% chlorhexidine for 14 days and the second bacteriologic samples were taken prior to root canal filling. Samples were submitted to microbiologic culture procedure to detect root canal bacteria and processed for checkerboard DNA-DNA hybridization. RESULTS Baseline microbial culture revealed high prevalence and cfu number of anaerobic, black-pigmented bacteroides, Streptococcus, and aerobic microorganisms. Following root canal dressing, the overall number of cfu was dramatically diminished compared to initial contamination (P <0.05), although prevalence did not change (P > 0.05). Of 35 probes used for checkerboard DNA-DNA hybridization, 31 (88.57%) were present at baseline, and following root canal dressing, the number of positive probes reduced to 13 (37.14%). Similarly, the number of bacterial cells diminished folowing application of calcium hydroxide/chlorhexidine root canal dressing (P = 0.006). CONCLUSION Apical periodontitis is caused by a polymicrobial infection, and a calcium hydroxide/chlorhexidine paste is effective in reducing the number of bacteria inside root canals when applied as a root canal dressing.
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Affiliation(s)
- Izabel Yoko Ito
- Department of Clinical Analysis, Toxicology and Bromatology, School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, SP, Brazil
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Awawdeh L, Al-Beitawi M, Hammad M. Effectiveness of propolis and calcium hydroxide as a short-term intracanal medicament against Enterococcus faecalis: a laboratory study. AUST ENDOD J 2009; 35:52-8. [PMID: 19703075 DOI: 10.1111/j.1747-4477.2008.00125.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the antimicrobial activity of propolis-based intracanal medicament against Enterococcus faecalis using infected dentine models, and to compare its antimicrobial efficacy with that of the non-setting calcium hydroxide paste when used as a short-term medication for 1 and 2 days. A total of 50 dentine discs of 7-mm length was obtained from extracted human teeth. Five dentine discs were kept sterile to serve as a negative control. The remaining 45 were contaminated with E. faecalis and divided into two groups (n = 20) in addition to five discs that served as a positive control. The discs were treated as follow: 20 discs were filled with propolis, while the other 20 discs were filled with non-setting calcium hydroxide. Microbiological sampling was performed utilising sterile paper point, headstrom file and disc immersion. Results showed that propolis was significantly more effective than non-setting calcium hydroxide against E. faecalis after short-term application, which made comparison from this prospect unlevelled. The most effective microbiological sampling technique was abrading the lumen with headstrom file. Propolis is very effective as intracanal medicament in rapidly eliminating E. faecalis ex vivo.
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Affiliation(s)
- Lama Awawdeh
- Department of Restorative Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
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17
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Silva RABD, Assed S, Nelson-Filho P, Silva LABD, Consolaro A. Subcutaneous tissue response of isogenic mice to calcium hydroxide-based pastes with chlorhexidine. Braz Dent J 2009; 20:99-106. [DOI: 10.1590/s0103-64402009000200002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 05/25/2009] [Indexed: 11/22/2022] Open
Abstract
This study was evaluated the response of subcutaneous connective tissue of isogenic mice to calcium hydroxide-based pastes with chlorhexidine digluconate (CHX). Seventy isogenic male BALB/c mice aged 6-8 weeks and weighing 15-20 g were randomly assigned to 8 groups. The animals received polyethylene tube implants as follows: Groups I, II, and III (n=10) - Calen® paste mixed with 0.4% CHX (experimental paste; Calen/CHX) for 7, 21, and 63 days, respectively; Groups IV, V, and VI (n=10) - UltraCal™ paste mixed with 2% CHX (experimental paste supplied by Ultradent Products Inc.; Ultracal/CHX) for 7, 21, and 63 days, respectively; and Groups VII and VIII (n=5): empty tube for 7 and 21 days, respectively. At the end of the experimental periods, the implants were removed together with the surrounding tissues (skin and subcutaneous connective tissue). The biopsied tissues were subjected to routine processing for histological analysis. Using a descriptive analysis and a four-point (0-3) scoring system, the following criteria were considered for qualitative and quantitative analysis of the tissue around the implanted materials: collagen fiber formation, tissue thickness and inflammatory infiltrate. A quantitative analysis was performed by measuring the thickness (µm), area (µm²) and perimeter (µm) of the reactionary granulomatous tissue formed at the tube ends. Data were analyzed statistically by the Kruskal-Wallis test and Dunn's post-test (α=0.05). Calen/CHX showed biocompatibility with the subcutaneous and reactionary tissues, with areas of discrete fibrosis and normal conjunctive fibrous tissue, though without statistically significant difference (p>0.05) from the control groups. In Groups I to III, there was a predominance of score 1, while in Groups IV to VI scores 2 and 3 predominated for all analyzed parameters. UltraCal/CHX, on the other hand, induced the formation of an inflammatory infiltrate and abundant exudate, suggesting a persistent residual aggression from the material, even 63 days after implant placement. In conclusion, the Calen paste mixed with 0.4% CHX allowed an adequate tissue response, whereas the UltraCal paste mixed with 2% CHX showed unsatisfactory results.
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18
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da Silva RAB, Leonardo MR, da Silva LAB, de Castro LMS, Rosa AL, de Oliveira PT. Effects of the association between a calcium hydroxide paste and 0.4% chlorhexidine on the development of the osteogenic phenotype in vitro. J Endod 2008; 34:1485-9. [PMID: 19026879 DOI: 10.1016/j.joen.2008.08.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 08/18/2008] [Accepted: 08/24/2008] [Indexed: 01/12/2023]
Abstract
The present study aimed to evaluate whether the association between a calcium hydroxide paste (Calen paste) and 0.4% chlorhexidine (CHX) affects the development of the osteogenic phenotype in vitro. With rat calvarial osteogenic cell cultures, the following parameters were assayed: cell morphology and viability, alkaline phosphatase activity, total protein content, bone sialoprotein immunolocalization, and mineralized nodule formation. Comparisons were carried out by using the nonparametric Kruskal-Wallis test (level of significance, 5%). The results showed that the association between Calen paste and 0.4% CHX did not affect the development of the osteogenic phenotype. No significant changes were observed in terms of cell shape, cell viability, alkaline phosphatase activity, and the total amount of bone-like nodule formation among control, Calen, or Calen + CHX groups. The strategy to combine Ca(OH)(2) and CHX to promote a desirable synergistic antibacterial effect during endodontic treatment in vivo might not significantly affect osteoblastic cell biology.
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Affiliation(s)
- Raquel Assed Bezerra da Silva
- Department of Pediatric Clinic, Preventive and Social Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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19
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Blome B, Braun A, Sobarzo V, Jepsen S. Molecular identification and quantification of bacteria from endodontic infections using real-time polymerase chain reaction. ACTA ACUST UNITED AC 2008; 23:384-90. [DOI: 10.1111/j.1399-302x.2008.00440.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Wang CS, Arnold RR, Trope M, Teixeira FB. Clinical efficiency of 2% chlorhexidine gel in reducing intracanal bacteria. J Endod 2008; 33:1283-9. [PMID: 17963947 DOI: 10.1016/j.joen.2007.07.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 06/18/2007] [Accepted: 07/01/2007] [Indexed: 10/22/2022]
Abstract
This study evaluated the clinical efficacy of 2% chlorhexidine (CHX) gel on intracanal bacteria reduction during root canal instrumentation. The additional antibacterial effect of an intracanal dressing (Ca[OH](2) mixed with 2% CHX gel) was also assessed. Forty-three patients with apical periodontitis were recruited. Four patients with irreversible pulpitis were included as negative controls. Teeth were instrumented using rotary instruments and 2% CHX gel as the disinfectant. Bacterial samples were taken upon access (S1), after instrumentation (S2), and after 2 weeks of intracanal dressing (S3). Anaerobic culture was performed. Four samples showed no bacteria growth at S1, which were excluded from further analysis. Of the samples cultured positively at S1, 10.3% (4/39) and 8.3% (4/36) sampled bacteria at S2 and S3, respectively. A significant difference in the percentage of positive culture between S1 and S2 (p < 0.001) but not between S2 and S3 (p = 0.692) was found. These results suggest that 2% CHX gel is an effective root canal disinfectant and additional intracanal dressing did not significantly improve the bacteria reduction on the sampled root canals.
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Affiliation(s)
- Ching S Wang
- Department of Endodontics, University of North Carolina School of Dentistry, Chapel Hill, North Carolina 27599, USA
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21
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Cook J, Nandakumar R, Fouad AF. Molecular- and Culture-based Comparison of the Effects of Antimicrobial Agents on Bacterial Survival in Infected Dentinal Tubules. J Endod 2007; 33:690-2. [PMID: 17509407 DOI: 10.1016/j.joen.2007.01.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2006] [Revised: 01/22/2007] [Accepted: 01/23/2007] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the effect of root canal obturation with or without prior calcium hydroxide (Ca(OH)(2)) or 2% chlorhexidine (CHX) on the persistence of bacteria or its DNA in infected dentinal tubules. Canals of 85 extracted teeth were instrumented and inoculated with 10(4) cells/mL of Enterococcus faecalis. Teeth were incubated at 37 degrees C for 21 days and divided into 3 groups of 25 teeth plus controls. Teeth in group 1 were obturated immediately with gutta-percha (GP) and AH-Plus (Maillefer, Dentsply, Tulsa, OK). In group 2, Ca(OH)(2) was placed for 7 days before obturation. In group 3, 10 minutes of irrigation was performed with CHX performed before obturation. After incubation, GP was removed, and dentin specimens were collected and analyzed with culturing and polymerase chain reaction (PCR). No growth occurred in any cultures. By using PCR, E faecalis was detected in fewer roots in group 3 than in groups 1 or 2 (chi(2), p = 0.05); 2% CHX treatment followed by obturation was more effective in removing E faecalis DNA than placement of Ca(OH)(2) or immediate obturation.
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Affiliation(s)
- Jerry Cook
- University of Maryland, Baltimore, Maryland 21201, USA
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22
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Siqueira JF, Paiva SSM, Rôças IN. Reduction in the cultivable bacterial populations in infected root canals by a chlorhexidine-based antimicrobial protocol. J Endod 2007; 33:541-7. [PMID: 17437868 DOI: 10.1016/j.joen.2007.01.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 01/05/2007] [Accepted: 01/09/2007] [Indexed: 11/24/2022]
Abstract
The present clinical study was conducted to assess the bacterial reduction after chemomechanical preparation using 0.12% chlorhexidine digluconate solution as an irrigant and the additive antibacterial effect of intracanal dressing with calcium hydroxide (Ca(OH)(2)) associated with 0.12% chlorhexidine digluconate gel. According to stringent inclusion/exclusion criteria, 13 teeth with primary intraradicular infections and chronic apical periodontitis were selected and followed in the study. Bacterial samples were taken at the baseline (before treatment) (S1), after chemomechanical preparation using chlorhexidine (CHX) as an irrigant (S2), and after a 7-day dressing with Ca(OH)(2)/CHX paste (S3). Cultivable bacteria recovered from infected root canals at the three stages were counted and identified by means of 16S ribosomal RNA gene sequencing analysis. At S1, all canals were positive for bacteria, with the mean number of 3.5 taxa per canal (range, 2-9). At S2, 7 cases (53.8%) still harbored cultivable bacteria, with a mean number of 1.7 taxon per canal (range, 1-4). At S3, only one case (7.7%) was positive for the presence of bacteria. The great majority of taxa found in posttreatment samples were gram-positive bacteria. A significantly high reduction in bacterial counts was observed between S1 and S2 and S1 and S3 (p<0.001). Also, significant differences were observed for comparisons involving S2 and S3 samples with regard to both quantitative bacterial reduction (p=0.014) and number of cases yielding negative cultures (p=0.01). It was concluded that chemomechanical preparation with 0.12% CHX solution as an irrigant significantly reduced the number of intracanal bacteria but failed to render the canal free of cultivable bacteria in about one half of the cases. Application of a 7-day intracanal dressing with Ca(OH)(2)/CHX paste further increased significantly the number of cases yielding negative cultures.
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Affiliation(s)
- José F Siqueira
- Department of Endodontics, Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, RJ, Brazil.
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23
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Oztan MD, Kiyan M, Gerçeker D. Antimicrobial effect, in vitro, of gutta-percha points containing root canal medications against yeasts and Enterococcus faecalis. ACTA ACUST UNITED AC 2006; 102:410-6. [PMID: 16920552 DOI: 10.1016/j.tripleo.2005.10.073] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 11/03/2005] [Accepted: 11/04/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to determine the in vitro susceptibility of Enterococcus faecalis and the most prevalent Candida species as therapy-resistant microorganisms to gutta-percha points containing root canal medications. STUDY DESIGN Gutta-percha points containing calcium hydroxide (Calcium Hydroxide Plus Points), chlorhexidine diacetate (Activ Points), or calcium hydroxide-chlorhexidine combinations (CHX/Ca Combi Points) were tested for their ability to inhibit growth of pure cultures of Candida albicans, Candida glabrata, Candida parapsilosis, Candida krusei, Candida tropicalis, Saccharomyces cerevisiae, and Enterococcus faecalis. Approximately 2 x 10(7) microorganisms per assay were suspended in diluted human serum and co-incubated with the gutta-percha points placed in Eppendorf tubes in an incubator for up to 2 weeks. A tube was removed at 1, 2, 3, 4, 7, and 14 days, and then opened and microorganism suspensions were serially diluted in a sterile 0.9% NaCl solution. Aliquots of the dilution steps were streaked onto solid medium. After incubating the plates in an incubator at 37 +/- 1 degrees C for 48 hours, CFU numbers per milliliter of suspension were calculated. RESULTS Calcium Hydroxide Plus Points or Activ Points did not exhibit sufficient antimicrobial or anticandidal activity for Enterococcus faecalis, Candida albicans, C. glabrata, C. parapsilosis, C. krusei, or C. tropicalis within 14 days. Only Saccharomyces cerevisiae was susceptible to the calcium hydroxide or chlorhexidine diacetate containing gutta percha points. CHX/Ca Combi Points killed C. albicans, C. glabrata, C. krusei, C. tropicalis, and S. cerevisiae completely. However, E. faecalis and C. parapsilosis were resistant to CHX/Ca Combi points within 14 days. CONCLUSION The results show the gutta percha points containing a mixture of calcium hydroxide and chlorhexidine diacetate have efficacies superior to calcium hydroxide or chlorhexidine diacetate alone against some microorganisms except E. faecalis and C. parapsilosis.
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Affiliation(s)
- Meltem Dartar Oztan
- Faculty of Dentistry, Department of Endodontics, Ankara University, Ankara, Turkey.
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24
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Ercan E, Dalli M, Dülgergil CT. In vitro assessment of the effectiveness of chlorhexidine gel and calcium hydroxide paste with chlorhexidine against Enterococcus faecalis and Candida albicans. ACTA ACUST UNITED AC 2006; 102:e27-31. [PMID: 16876041 DOI: 10.1016/j.tripleo.2006.02.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 02/14/2006] [Accepted: 02/18/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the effectiveness of various medicaments, including Ca(OH)2/2% chlorhexidine, 2% chlorhexidine gel, and Ca(OH)2 alone, against Enterococcus faecalis and Candid albicans in vitro. STUDY DESIGN Eighty extracted single-rooted human maxillary teeth were used. After removing the crown, each root was instrumented up to size 50 by using a conventional technique. The root canal was irrigated with ethylenediamine tetra-acetic acid (EDTA) solution to remove smear layer. Then, roots were infected with E faecalis and C albicans. Subsequently, the roots were divided into 4 treatment groups: group 1 was treated with calcium powder hydroxide in distilled water, group 2 was treated with calcium hydroxide powder in 2% chlorhexidine, group 3 was treated with 2% chlorhexidine gel, and group 4 was treated with 0.9% sterile saline serving as negative control. Microbial samples were taken after 7, 15, and 30 days. After incubation, dentine chips were obtained form each root canal and examined microbiologically. The microbiological samples were plated to count colony-forming units in per milligram of dentin. RESULTS The results showed that the 2% chlorhexidine gel was significantly more effective than calcium hydroxide with 2% chlorhexidine, calcium hydroxide, and control saline solution (P < .05). CONCLUSION Under the conditions of this study, 2% chlorhexidine gel is effective in the elimination of E faecalis and C albicans from the root canal system. However, to support this in vitro observation, further in vivo studies are needed.
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Affiliation(s)
- Ertuğrul Ercan
- Department of Operative Dentistry, School of Dentistry, University of Kirikkale, Kirikkale, Turkey.
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25
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Ogawa AT, Brasil de Souza TDAC, de Uzeda M, Jankevicius JV, Jankevicius SI. Characterization of proteolytic activities of Fusobacterium nucleatum. J Endod 2006; 32:521-3. [PMID: 16728241 DOI: 10.1016/j.joen.2005.10.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This investigation attempted to detect the proteolytic activity of Fusobacterium nucleatum in living cells, lysate cells, and supernatant of cultures. The reactions were optimized in their pH, temperature, reaction time, enzyme source, and substrate volume. Synthetic substrates beta-naphthylamides (Cys-Na, Ser-Na, Leu-Na, Glu-Na, Lys-Na and BANA), carbobenzoxy L-tirosine p-nitrophenylester (CTN), and natural substrate azoalbumin were used. Reaction occurred with Cys-Na, Ser-Na, and Glu-Na in living cells and with Glu-Na, Leu-Na, and CTN substrates in lysate cells. The supernatant reacted only with Glu-Na. Optimal pH ranged from 6.0 to 7.5, except for CTN (pH 13), and optimal temperature, between 30 and 40 degrees C. Optimal reaction time was 60 min, except for Glu-Na in living cells (40 min), lysate cells (20 min), and CTN substrate (80 min). There was no activity with Lys-Na, BANA, and azoalbumin. Proteolytic activity was assessed by several inhibitors and the presence of metallo, serine, cysteine, and aspartic proteases were detected.
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Affiliation(s)
- Alice Tayoko Ogawa
- Departamento de Microbiologia/CCB, Universidade Estadual de Londrina, Londrina Paraná, Brasil
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26
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Lambrianidis T, Kosti E, Boutsioukis C, Mazinis M. Removal efficacy of various calcium hydroxide/chlorhexidine medicaments from the root canal. Int Endod J 2006; 39:55-61. [PMID: 16409329 DOI: 10.1111/j.1365-2591.2005.01049.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To compare the efficiency of removing calcium hydroxide [Ca(OH)(2)]/chlorhexidine (CHX) (gel), Ca(OH)(2)/CHX (solution) and Ca(OH)(2)/saline pastes with the use of instrumentation and irrigation with sodium hypochlorite and ethylene diamine tetraacetic acid (EDTA) solutions. Moreover the role of the patency file in the cleanliness of the apical third of the root canal was evaluated. METHODOLOGY Sixty-four human single-rooted teeth with straight canals were used. Root canal preparation was performed with a stepback technique using Hedström (H) files. Teeth were randomly assigned to three groups and subsequently filled with one of the pastes: Ca(OH)(2)/CHX (gel), Ca(OH)(2)/CHX (solution) and Ca(OH)(2)/saline paste. The medicaments were removed 10 days later using instrumentation and irrigation with 1% sodium hypochlorite and 17% EDTA, with or without obtaining patency of the apical foramen with a size 10 H-file. The crowns were removed at the cemento-enamel junction and the roots were grooved longitudinally and split into halves. Images of all halves were acquired with the use of a flatbed scanner. A scoring system of 1 to 4 was used to assess the amount of residue on the cervical, middle and apical third of the canal. Data were subjected to statistical analysis using Kruskal-Wallis and Mann-Whitney tests, with Bonferroni correction, at 95% confidence level (P < 0.05). RESULTS Remnants of medicament were found in all experimental teeth regardless of the experimental material used and the use of the patency file. When examining the root canal as a whole, Ca(OH)(2)/CHX (gel) paste was associated with significantly larger amount of residue, whereas the Ca(OH)(2)/CHX (solution) paste was associated with less amount (P < 0.05) than the other two medicaments with or without the use of a patency file. CONCLUSIONS None of the techniques used in this study removed the inter-appointment root canal medicaments effectively; the use of the patency file facilitated removal of more of the medicament in the apical third of those straight canals.
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Affiliation(s)
- T Lambrianidis
- Department of Endodontology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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George S, Kishen A, Song KP. The Role of Environmental Changes on Monospecies Biofilm Formation on Root Canal Wall by Enterococcus faecalis. J Endod 2005; 31:867-72. [PMID: 16306820 DOI: 10.1097/01.don.0000164855.98346.fc] [Citation(s) in RCA: 185] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Biofilm mode of growth is a strategy in microorganisms to survive harsh growth conditions. Although previous studies have established the ability of Enterococcus faecalis to survive postendodontic environmental conditions, the effect of such conditions on the ultrastructural and physiochemical features of E. faecalis biofilm has received less attention. This study aims to evaluate the effect of different growth conditions on the characteristics of E. faecalis biofilm on root canal, and the penetration of E. faecalis into dentinal tubules. Forty-five intact noncarious human maxillary molars were experimented under nutrient-rich, nutrient-deprived, aerobic, and anaerobic conditions for a period of 21 days. Scanning Electron Microscopy with Energy Dispersive X-ray microanalysis, Laser Confocal Scanning Microscopy and Light microscopic examinations were carried out. The microscopic analysis highlighted a distinct variation in the ultrastructure of the biofilms formed under different experimental conditions. The EDX microanalysis showed a significant increase in the levels of Calcium (Ca) in the biofilm structures formed under anaerobic nutrient-deprived condition (p < 0.001). The depth of bacterial penetration was significantly greater in nutrient-rich condition (p < 0.001). This study demonstrated distinct ultrastructural and physiochemical properties of the biofilms formed and dentinal tubular penetration of E. faecalis under different conditions.
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Affiliation(s)
- S George
- Department of Restorative Dentistry, Faculty of Dentistry, National University of Singapore, Singapore
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Zerella JA, Fouad AF, Spångberg LSW. Effectiveness of a calcium hydroxide and chlorhexidine digluconate mixture as disinfectant during retreatment of failed endodontic cases. ACTA ACUST UNITED AC 2005; 100:756-61. [PMID: 16301159 DOI: 10.1016/j.tripleo.2005.05.072] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Revised: 01/15/2004] [Accepted: 05/17/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this in vivo investigation is to compare the effect of a slurry of Ca(OH)2 mixed in aqueous 2% chlorhexidine (CHX) versus aqueous Ca(OH)2 slurry alone on the disinfection of the pulp space of failed root-filled teeth during endodontic retreatment. STUDY DESIGN Forty single-rooted previously root-filled teeth with associated periradicular lesions were included. The teeth were nonsurgically retreated and medicated over 3 treatment visits with 7-10-day intervals with either Ca(OH)2 in water or Ca(OH)2 in 2% aqueous CHX. Root canal cultures were collected in fluid thioglycollate, and bacterial growth was assessed by turbidity daily for 1 week, then weekly for an additional 3 weeks. The presence of enterococci in the root canals at the initial treatment session was determined. RESULTS Of the total sample population, 12 of 40 (30%) were positive for bacteria before root filling. The control medication disinfected 12 of 20 (60%) teeth including 2 of 4 teeth originally diagnosed with enterococci. The experimental medication resulted in disinfected 16 of 20 (80%) teeth at the beginning of the third appointment. None of the teeth originally containing enterococci showed remaining growth. This difference between the overall positive cultures was not statistically significant (P > .05). CONCLUSIONS Canal dressing with a mixture of 2% CHX and Ca(OH)2 slurry is as efficacious as aqueous Ca(OH)2 on the disinfection of failed root-filled teeth.
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Affiliation(s)
- Joseph A Zerella
- Department of Endodontology, School of Dental Medicine, University of Connecticut, Farmington, Conn, USA.
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Abstract
The purpose of this study was to test the ability of a commercially available iodoform gutta-percha, to delay infiltration of Enterococcus faecalis using a microleakage model. Seventy extracted single-rooted teeth were decoronated and biomechanically prepared using hand and rotary instruments. Thirty roots were obturated laterally with iodoform gutta-percha and another 30 with regular gutta-percha. Both groups were suspended in sterile BHI broth. An inoculum of E. faecalis suspension was placed at the coronal end of each root, incubated and replenished daily. The apical broth was observed for turbidity, indicating bacterial microleakage. Samples were observed for 32 days, and data was analyzed to compare microleakage between the two groups. The results showed no significant difference between the iodoform and regular gutta-percha samples in delaying microleakage of E. faecalis (p > 0.05).
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Affiliation(s)
- Sami Chogle
- Case Western Reserve University School of Dental Medicine, Cleveland, Ohio 44106-4905, USA.
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Eddy RS, Joyce AP, Roberts S, Buxton TB, Liewehr F. An In Vitro Evaluation of the Antibacterial Efficacy of Chlorine Dioxide on E. faecalis in Bovine Incisors. J Endod 2005; 31:672-5. [PMID: 16123704 DOI: 10.1097/01.don.0000155223.87616.02] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study investigated the ability of chlorine dioxide to eliminate Enterococcus faecalis from dentinal tubules of bovine incisors. Thirty-seven extracted bovine incisor roots were sectioned into seventy-four 5 mm disks. Standardized lumens were filled with either sterile Brain Heart Infusion Broth (contamination controls, n = 10) or BHI containing E. faecalis (1.0 x 10 cfu/ml). Disks were incubated in 5% CO2 at 37 degrees C for 72 h. To simulate endodontic instrumentation the lumens were again enlarged. Sixty disks were randomly divided into four experimental groups and filled with one of the following irrigants: 10% Clidox-S (chlorine dioxide), 13.8% BioClenz (chlorine dioxide), 5.25% Clorox, or saline. The disks were incubated for 30 min and were then frozen, pulverized, serially diluted in phosphate buffered saline, and plated on BHI plates in triplicate. Total colony forming units were counted macroscopically. Statistical analysis of the data was performed with a Kruskal-Wallis one-way ANOVA on ranks (p < 0.05, n = 60). Bacterial counts, expressed in log10 cfu/disk were as follows (">" denotes significant differences): Saline > Clidox-S = BioClenz > Clorox. All negative controls were sterile. Chlorine dioxide and NaOCL were both effective in eliminating E. faecalis from the dentinal disks within 30 min.
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Affiliation(s)
- Russell S Eddy
- U.S. Army Endodontic Residency Program, Fort Gordon, Georgia, USA
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Portenier I, Waltimo T, Ørstavik D, Haapasalo M. The Susceptibility of Starved, Stationary Phase, and Growing Cells of Enterococcus faecalis to Endodontic Medicaments. J Endod 2005; 31:380-6. [PMID: 15851934 DOI: 10.1097/01.don.0000145421.84121.c8] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this investigation was to compare the susceptibility of cells of Enterococcus faecalis during exponential growth, stationary phase and starvation phase to three endodontic medicaments. E. faecalis strains VP3-80 and A197A in different growth phases were exposed to saturated calcium hydroxide solution, 0.05% chlorhexidine digluconate and 0.0001% sodium hypochlorite. Cells in the exponential growth phase were the most sensitive to all three medicaments and were killed between 3 s and 10 min. Cells in stationary phase were more resistant and living cells could be recovered at 10 min. However, cells in starvation phase were the most resistant and were not totally eliminated by the medicaments during the 10-min test period. Number of surviving cells of E. faecalis cells to the tested medicaments increased 1000- to 10,000-folds in aging cultures.
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Affiliation(s)
- Isabelle Portenier
- Department of Endodontics, Dental Faculty, University of Oslo, Oslo, Norway.
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Abstract
In this study, optical spectroscopy was used to monitor a chromogenic, enzyme-substrate reaction for the rapid identification of Enterococcus faecalis. The detection system, comprising a miniature spectrophotometer and an accompanying data acquisition system, was placed in an incubator. During testing, a 3-ml test sample was placed in a cuvette within the spectrophotometer. This permitted online, real-time, and remote analysis of spectral signature needed to monitor the bacteria. It was observed that the absorption peak intensity increased conspicuously 3.5 h after inoculation and through the entire period of testing. A linear-regression analysis demonstrated a significant correlation between the increase in absorption peak intensity at 610 nm (r = 0.9389) and 653 nm (r = 0.9387) with the formation of colony-forming units. Optical spectroscopy-based sensing systems can pave the way for rapid, nonlaboratory-based approaches to monitor microbial status quantitatively and qualitatively from clinical samples.
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Affiliation(s)
- A Kishen
- Department of Restorative Dentistry, Faculty of Dentistry, National University of Singapore.
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de Souza CAS, Teles RP, Souto R, Chaves MAE, Colombo APV. Endodontic Therapy Associated with Calcium Hydroxide As an Intracanal Dressing: Microbiologic Evaluation by the Checkerboard DNA-DNA Hybridization Technique. J Endod 2005; 31:79-83. [PMID: 15671813 DOI: 10.1097/01.don.0000133157.60731.3f] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study evaluated the predominant microbiota of infected necrotic pulps and the effects of calcium hydroxide therapy on these microorganisms by the checkerboard DNA-DNA hybridization technique. Conventional endodontic therapy associated with calcium hydroxide as intracanal dressing was performed in 12 single-rooted teeth with pulp necrosis and periradicular bone lesion. Samples were collected from the canal at baseline and 14 days after therapy, and the presence of 44 bacterial species was determined by the checkerboard method. Significant differences in the microbiota from baseline to post-therapy were sought by the paired-samples t test. The most prevalent species included F. nucleatum ss. vincentii, C. sputigena, C. ochracea, S. constellatus, V. parvula, P. gingivalis, P. melaninogenica, and S. sanguis. Most of the microorganisms were reduced after treatment, particularly A. gerencseriae, A. israelii, A. naeslundii, C. gingivalis, C. ochracea, P. gingivalis, S. noxia, S. sanguis, and S. oralis (p < 0.05). Conversely, A. actinomycetemcomitans, C. sputigena, and E. corrodens increased in numbers after therapy. These results indicate that conventional endodontic therapy with calcium hydroxide results in the reduction of pathogenic species associated with pulp necrosis. However, its use is limited, because it did not eliminate the whole spectrum of microorganisms.
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Rahman MJ, Sarker P, Roy SK, Ahmad SM, Chisti J, Azim T, Mathan M, Sack D, Andersson J, Raqib R. Effects of zinc supplementation as adjunct therapy on the systemic immune responses in shigellosis. Am J Clin Nutr 2005; 81:495-502. [PMID: 15699240 DOI: 10.1093/ajcn.81.2.495] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Zinc is lost during diarrheal diseases, and zinc deficiency induces intestinal morphology-altering inflammatory responses that zinc supplementation can correct. OBJECTIVE We assessed the in vivo effect of zinc supplementation on systemic and mucosal responses in mildly to moderately malnourished (defined as <-1 but >-2 and <-2 but >-3 weight-for-height z scores, respectively, based on the National Center for Health Statistics growth reference) children with shigellosis. DESIGN A double-blind placebo-controlled trial was conducted in Shigella flexneri-infected children aged 12-59 mo. Daily for 14 d, elemental zinc (20 mg) and multivitamins (vitamins A and D, thiamine, riboflavin, and nicotinamide) plus calcium were given at twice the US recommended dietary allowance to the zinc group (n=28), and multivitamins plus calcium were given to the control group (n=28). All subjects received standard antibiotic therapy. RESULTS There was no significant interaction between zinc supplementation and time, but zinc supplementation showed a significant effect on serum zinc concentrations. With a >or=4-fold increase in serum shigellacidal antibody titers from baseline used as the cutoff, the proportion of children with shigellacidal antibody response was greater in the zinc group than in the control group (P<0.03). There was a significant (P=0.02) treatment x time interaction for the proportions of circulating CD20+ and CD20+CD38+ cells, which were higher on day 7 in the zinc group than in the control group (P<0.007). No effect was seen on histopathologic features or the expression of innate and inflammatory mediators in the rectum. CONCLUSION Adjunct therapy with zinc during acute shigellosis significantly improved seroconversion to shigellacidal antibody response and increased the proportions of circulating B lymphocytes and plasma cells.
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Affiliation(s)
- Muhammad J Rahman
- International Centre for Health and Population Research, Bangladesh, Dhaka, Bangladesh
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Schäfer E, Bössmann K. Antimicrobial Efficacy of Chlorhexidine and Two Calcium Hydroxide Formulations Against Enterococcus faecalis. J Endod 2005; 31:53-6. [PMID: 15614008 DOI: 10.1097/01.don.0000134209.28874.1c] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate the efficacy of chlorhexidine (CHX) and calcium hydroxide (Ca(OH2) against Enterococcus faecalis in vitro. Extracted single-rooted human teeth were instrumented up to size 40. After removal of the smear layer, an inoculum of E. faecalis was inserted into the root canals. After incubation, the inoculum was removed and the root canals were filled with one of three different disinfectants: Ca(OH2 paste, CHX 2%, and a mixture of CHX and Ca(OH2 paste (n = 10 in each group). Control teeth were filled with water of standardized hardness (n = 10). The teeth were then incubated for 3 days. After incubation, each root canal was instrumented, and the removed dentin was examined microbiologically. CHX was significantly more effective against E. faecalis than was Ca(OH2 paste or a mixture of CHX with Ca(OH2 paste (p < 0.05). There was no increase in the efficiency of Ca(OH2 paste when CHX was added (p > 0.05). The results suggest that CHX is effective in the elimination of E. faecalis from dentinal tubules under the conditions of this study.
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Affiliation(s)
- Edgar Schäfer
- Poliklinik für Zahnerhaltung, University School of Dentistry, Münster, Germany.
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Cwikla SJ, Bélanger M, Giguère S, Progulske-Fox A, Vertucci FJ. Dentinal Tubule Disinfection Using Three Calcium Hydroxide Formulations. J Endod 2005; 31:50-2. [PMID: 15614007 DOI: 10.1097/01.don.0000134291.03828.d1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to determine the antibacterial efficacy of three calcium hydroxide (CH) formulations using an in vitro model of Enterococcus faecalis dentinal tubule infection. CH mixed with water (CH), CH mixed with iodine-potassium iodide (CH+IKI), and CH mixed with iodoform and silicone oil (Metapex) were tested. Human cylindrical dentin specimens infected with E. faecalis were filled with disinfectants and incubated for 1 week. Dentin powder samples collected with ISO 018 burs showed a statistically significant reduction in E. faecalis for all three experimental groups in comparison with untreated control specimens. Statistically significant differences were also found between the three experimental groups. Metapex was the most effective dentinal tubule disinfectant, followed by CH+IKI and then CH. Similar results were observed at greater dentin tubule depths (ISO 021 burs) with the exception that intracanal treatment with CH resulted in significantly higher numbers of E. faecalis in comparison with untreated control specimens.
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Affiliation(s)
- Stephen J Cwikla
- Center for Molecular Microbiology, Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, Florida 32610-0424, USA
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do Amorim CVG, Aun CE, Mayer MPA. Susceptibility of some oral microorganisms to chlorhexidine and paramonochlorophenol. Braz Oral Res 2004; 18:242-6. [PMID: 15619879 DOI: 10.1590/s1806-83242004000300012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Since the use of antimicrobial agents is required in endodontic therapies, this study aimed at determining the minimum inhibitory concentrations (MICs) of chlorhexidine digluconate and paramonochlorophenol (PMC) against microorganisms commonly found in endodontic infections. Both agents were tested by agar dilution tests against Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Candida albicans, Prevotella intermedia, Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella denticola and Prevotella melaninogenica. The MIC of chlorhexidine ranged from 2.67 to 80.00 µg/ml, and the MIC of PMC from 46.67 to 213.33 µg/ml. The highest MIC value of PMC was detected for E. faecalis whereas E. coli was the most susceptible microorganism to this agent. The highest MIC values of chlorhexidine were observed for P. aeruginosa whereas E. coli and P. denticola were the most susceptible microorganisms to this agent. Since the MIC values observed are much lower than the concentrations currently used in the endodontic therapy, it is suggested that both agents are effective in reducing the microbiota in the root canal.
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Polymerase Chain Reaction Identification of Microorganisms in Previously Root-Filled Teeth in a South Korean Population. J Endod 2004. [DOI: 10.1097/00004770-200407000-00011] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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