Effect of Hydrogen Peroxide on the Antibacterial Substantivity of Chlorhexidine

Synergistic Antibacterial Efficacies of Chlorhexidine Digluconate or Protamine Sulfate Combined with Laminaria japonica or Rosmarinus officinalis Extracts against Streptococcus mutans

Chlorhexidine digluconate inhibits oral bacteria and the formation of dental plaque. Protamine sulfate, a polycationic protein, exerts antibacterial activity by altering the cell wall of bacteria. Extracts of Laminaria japonica and Rosmarinus officinalis display antimicrobial effects against oral pathogens. The purpose of this study was to investigate the synergistic effect of chlorhexidine digluconate and protamine sulfate on the inhibitory activity of L. japonica and R. officinalis extracts against Streptococcus mutans, a major etiological agent for dental caries. Minimal inhibitory concentrations (MICs) of chlorhexidine digluconate, protamine sulfate, and L. japonica and R. officinalis extracts were determined by broth dilution method. Synergistic effect of chlorhexidine digluconate or protamine sulfate and extracts of L. japonica or R. officinalis was determined by fractional inhibitory concentration index (FIC). FIC demonstrated the synergistic effects of the different combinations of antibacterial agents. In this study, the use of sub-MIC of chlorhexidine digluconate or protamine sulfate with sub-MIC of L. japonica and R. officinalis extracts resulted in synergistic inhibitory effects of these antibacterial agents except for chlorhexidine digluconate and L. japonica combination.

Synergistic antibacterial activity of chlorhexidine and hydrogen peroxide against Enterococcus faecalis

The aim of the present study was to compare the in vitro antibacterial activity of common root canal irrigants with a combination technique against intratubular Enterococcus faecalis. Seventy-five human single-rooted teeth were selected and their crowns and root-ends were removed to obtain specimens 5 mm in length. The specimens were contaminated with E. faecalis and divided into five experimental groups (n = 15). These groups were irrigated with 2% chlorhexidine (CHX), 3% hydrogen peroxide (H2O2), 5.25% sodium hypochlorite (NaOCl), CHX/H2O2 and sterile saline (control). Surface and deep dentinal chips were collected for each sample. After incubation, the numbers of colony-forming units (CFUs) were counted. The Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis (α = 0.05). In the surface dentin, CHX, NaOCl, and CHX/H2O2 had significantly higher antibacterial activity than H2O2 (P < 0.05). In the deep dentin, NaOCl and CHX/H2O2 had significantly higher antibacterial activity than CHX and H2O2 (P < 0.05). CHX/H2O2 had similar antibacterial effectiveness to NaOCl in both surface and deep dentinal tubules. This combination can be considered a potentially useful irrigant for root canal treatment.