Activity of endodontic antibacterial agents against selected anaerobic bacteria

Bacterial sensitivity to chlorhexidine and povidone-iodine antiseptics over time: a systematic review and meta-analysis of human-derived data

Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis, minimising SSIs. There is concern that  resistance to topical biocides may be emergeing, although the potential clinical implications remain unclear. The objective of this systematic review was to determine whether the minimum bactericidal concentration (MBC) of topical preparations of CHX or PVI have changed over time, in microbes relevant to SSI. We included studies reporting the MBC of laboratory and clinical isolates of common microbes to CHX and PVI. We excluded studies using non-human samples and antimicrobial solvents or mixtures with other active substances. MBC was pooled in random effects meta-analyses and the change in MBC over time was explored using meta-regression. Seventy-nine studies were included, analysing 6218 microbes over 45 years. Most studies investigated CHX (93%), with insufficient data for meta-analysis of PVI. There was no change in the MBC of CHX to Staphylococci or Streptococci over time. Overall, we find no evidence of reduced susceptibility of common SSI-causing microbes to CHX over time. This provides reassurance and confidence in the worldwide guidance that CHX should remain the first-choice agent for surgical skin antisepsis.

Insight into Oral Biofilm: Primary, Secondary and Residual Caries and Phyto-Challenged Solutions

INTRODUCTION

Dental caries is known to be one of the most widespread, chronic infections affecting all ages and populations worldwide. The plethora of oral microbial population paves way for various endogenous infections and plays a crucial role in polymicrobial interactions contributing to biofilm-mediated diseases like caries and periodontal diseases.

METHODS

Extensive literature survey was conducted using the scientific databases like PubMed, Google scholar, Science Direct, etc. using the key words like dental caries, orodental infections, dental microbes, dental biofilm, secondary caries, phytotherapy, etc. The literature was analyzed thoroughly and critical review was performed.

RESULTS

The risk of development of secondary caries and residual caries further results in treatment failure. Drug resistance developed by oral microbes and further side effects pose serious hurdles in the current therapeutic strategies. The hyperactivities of various MMPs and the resulting massive ECM degradation are the challenging part in the design of effective therapeutic approaches. Anticariogenic phytotherapy is well appreciated owing to lesser side effects and versatility of their action. But appreciable outcomes regarding the phytochemical bioavailability and bioretention are still challenging. Site-specific delivery of phytoagents at the infected site may enhance the efficiency of these drugs. Accordingly emerging phytodentistry can be promising for the management of secondary and residual caries.

CONCLUSION

This article presents major cariogens and their mechanisms in initiating and aggravating dental caries. Effectiveness of phytotherapy and different mode of action of phytochemicals against cariogens are outlined. The article also raises major concerns and possibilities of phytochemical based therapeutics to be applied in the clinical arena of caries management.

Antimicrobial action of sodium hypochlorite and castor oil solutions for denture cleaning - in vitro evaluation

The objective of this in vitro study was to evaluate the antimicrobial action of sodium hypochlorite (0.25% and 0.50%) and 10% castor oil solutions against specific microorganisms, by counting Colony Forming Units (CFU) of clinically important bacteria and Candida species. Acrylic resin specimens (n = 320; Lucitone 550) were obtained from square metal matrices (10 x 10 x 2 mm), sterilized by microwave (650W, for 6 minutes) and contaminated by Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, Bacillus subtilis, Escherichia coli, Streptococcus mutans, Enterococcus faecalis and Candida glabrata. The specimens were immersed for 20 minutes in one of the following hygiene solutions (n = 10/each): A - 0.25% Sodium hypochlorite; B - 0.5% Sodium hypochlorite; C - 10% Castor oil solution; and D (Control) - saline. Adhered cells were suspended and inoculated into a selective solid medium (37ºC for 24 h). The Student's t-test (α = 0.05) was performed to compare log10(CFU+1)/mL between Groups C and D. The results showed that sodium hypochlorite (0.25% and 0.5%) completely eliminated all detectable microorganisms. The castor oil solution eliminated B. subtilis and reduced counts for other strains. Differences between C and D were significant (p < 0.05) for all species except for E. faecalis. Both sodium hypochlorite solutions (0.25% and 0.5%) were effective in eliminating all microorganisms evaluated, and may be useful as cleaning solutions for complete dentures. The castor oil solution provided moderate efficacy and performed differently on the tested species, with the strongest effect on B. subtilis and with non-significant action on E. faecalis.

A castor oil-containing dental luting agent: effects of cyclic loading and storage time on flexural strength

Favorable results in the use of castor oil polyurethane (COP) as pulp capping, membrane material, sealer, mouthwash and in bone repair, associated with the fact that Ricinus communis is not derived from petroleum and it is abundant in Brazil, encourage researches in the development of luting agents.

Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part I. In vitro studies

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.

In Vitro Antimicrobial Activity of an Experimental Dentifrice Based on Ricinus Communis

This study evaluated the antimicrobial activity of a Ricinus communis-based experimental dentifrice for denture hygiene against the following standard strains: Staphylococcus aureus, Escherichia coli, Streptococcus mutans, Enterococcus faecalis, Candida albicans and Candida glabrata. The minimum inhibitory concentration (MIC) assay was performed with R. communis in pure oil at 2.5%. Only E. coli was not inhibited by R. communis, but the MIC (0.0781%) was effective against the other microorganisms. From these results it was determined the R. communis concentrations for experimental dentifrices, 1, 2, 5 and 10%, which were evaluated by the test-well diffusion in agar. The commercial dentifrices Colgate, Trihydral and Corega Brite were tested for comparative purposes. The diameter of the zones of bacterial growth inhibition produced around the wells was measured (in mm) with a rule under reflected light. Data were analyzed statistically by analysis of variance and Tukey's post-hoc test (α=0.05). Neither the commercial nor the experimental dentifrices were effective against E. coli. The experimental dentifrices containing R. communis at 2, 5 and 10% presented action against S. mutans, S. aureaus and E. faecallis. The experimental dentifrices showed no antimicrobial activity against Candida spp. and E. coli in any of the tested concentrations. Trihydral was the most effective. Comparing the experimental dentifrices, the product with 10% R. communis produced the largest zones of bacterial growth inhibition and had similar antimicrobial activity to the commercial dentifrices, except against S. aureus.

Antimicrobial activity of isothiocyanates (ITCs) extracted from horseradish (Armoracia rusticana) root against oral microorganisms

The antimicrobial activity of isothiocyanates (ITCs) extracted from horseradish root was investigated against oral microorganisms: 6 strains of facultative anaerobic bacteria, Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Staphylococcus aureus, Enterococcus faecalis and Aggregatibacter actinomycetemcomitans; one strain of yeast, Candida albicans, and 3 strains of anaerobic bacteria, Fusobacterium nucleatum, Prevotella nigrescens, and Clostridium perfringens. The ITCs extracted from horseradish root showed antimicrobial activity against all oral microorganisms by the paper disk method. The minimum bactericidal concentration (MBC) of the ITCs extracted from horseradish root ranged from 1.25 to 5.00 mg/ml against 6 strains of facultative anaerobic bacteria and one strain of yeast, and 4.17 to 16.67 mg/ml against 3 strains of anaerobic bacteria. The ITCs extracted from horseradish root showed the strongest antimicrobial activity, with a MBC of 1.25 mg/ml, against C. albicans among facultative microorganisms, and 4.17 mg/ml against F. nucleatum among anaerobic bacteria. These results suggest that the ITCs extracted from horseradish root may be a candidate for use as an antimicrobial agent against oral microorganisms.

Effect of final irrigating solution on smear layer removal and penetrability of the root canal sealer

Objective:

To evaluate the effect of final rinsing solution on smear layer removal through penetrability of the root canal sealer.

Materials and Methods:

Each of the 30 teeth selected was decoronated and the root length standardized at 16 mm measured from the apex of the tooth to the cementoenamel junction (CEJ). A size 10-k file was used and working length was determined by subtracting 1mm from the measured length so that the length of the sample was 15mm. A combination of step back and crown down technique was done and apical portion was prepared till H-file no. 30. 3% NaOCl was used during cleaning and shaping of the canals. Finally the teeth were divided into three groups of 10 teeth each. Group-I was irrigated with 17% EDTA, Group-II with TUBLICID plus, and Group-III with Biopure MTAD^®. ISO 30 size gutta-percha points were selected as master cones. The Acroseal sealer was mixed with approximated concentration 0.1% fluorescent rhodamine B isothiocyanate dye. Obturation was done and after 48 hours, the roots were sectioned and subjected to confocal laser scanning microscopy.

Results:

Comparisons among the three groups were done by two-way analysis of variance (ANOVA) and Newman-Keuls multiple post-hoc procedures. The two-way ANOVA showed statistically highly significant results. The maximum depth of sealer penetration was observed in Group II followed by Group III and Group I.

Conclusion:

The use of -Tubulicid plus as a final irrigant provided better smear layer removal than Biopure a mixture of doxicycline, citric acid and a detergent (Tween 80) (MTAD^®) and 17% EDTA.

In vitro antimicrobial activity of auxiliary chemical substances and natural extracts on Candida albicans and Enterococcus faecalis in root canals

OBJECTIVE

The aim of this study was to evaluate the antimicrobial activity of auxiliary chemical substances and natural extracts on Candida albicans and Enterococcus faecalis inoculated in root canals.

MATERIAL AND METHODS

Seventy-two human tooth roots were contaminated with C. albicans and E. faecalis for 21 days. The groups were divided according to the auxiliary chemical substance into: G1) 2.5% sodium hypochlorite (NaOCl), G2) 2% chlorhexidine gel (CHX), G3) castor oil, G4) glycolic Aloe vera extract, G5) glycolic ginger extract, and G6) sterile saline (control). The samples of the root canal were collected at different intervals: confirmation collection, at 21 days after contamination; 1st collection, after instrumentation; and 2nd collection, seven days after instrumentation. Microbiological samples were grown in culture medium and incubated at 37°C for 48 hours.

RESULTS

The results were submitted to the Kruskal-Wallis and Dunn (5%) statistical tests. NaOCl and CHX completely eliminated the microorganisms of the root canals. Castor oil and ginger significantly reduced the number of CFU of the tested bacteria. Reduction of CFU/mL at the 1st and 2nd collections for groups G1, G2, G3 and G4 was greater in comparison to groups G5 and G6.

CONCLUSION

It was concluded that 2.5% sodium hypochlorite and 2% chlorhexidine gel were more effective in eliminating C. albicans and E. faecalis, followed by the castor oil and glycolic ginger extract. The Aloe vera extract showed no antimicrobial activity.

Diametral tensile strength and film thickness of an experimental dental luting agent derived from castor oil

The need to develop new dental luting agents in order to improve the success of treatments has greatly motivated research.

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

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.

Calcium hydroxide paste as a surface detoxifying agent for infected dental implants: two case reports

Dental implant treatment is successful; however, an implant can become infected during or after osseointegration. The two case reports presented here demonstrate, anecdotally, the effectiveness of endodontic calcium hydroxide paste for the surface treatment of infected, healing, or osseointegrated dental implants. Calcium hydroxide may be an appropriate surface detoxifying agent for local dental implant infections. A sequence of calcium hydroxide and 0.2% chlorhexidine gluconate surface treatment may provide a broad range of antimicrobial action for detoxifying recalcitrant infections. Calcium hydroxide should not be left in the surgical site.

Morphologic and morphometric analysis of the root canal apical third cleaning after biomechanical preparation using 3.3% Ricinus communis detergent and 1% NaOCl as irrigating solutions

This study evaluated, by morphologic and morphometric analyses, the cleaning of apical third of root canals instrumented with nickel-titanium rotary files using different irrigating solutions. Twenty-seven single-rooted mandibular premolars were assigned to three groups (n=9), according to the irrigating solution used: Group I, distilled and deionized water; Group II, 1% NaOCl; and Group III, 3.3% Ricinus communis detergent. Biomechanical preparation was performed with Protaper Plusâ nickel-titanium files as follows: S1, SX and S2 at the cervical and middle thirds, and 25/02, 25/04, 25/06, 30/02, 30/04 and 30/06 to complete the instrumentation, operating at 1 mm from the root apex. Irrigation was done at each file change with 2 mL of irrigating solution, totalizing 20 mL for each tooth. After biomechanical preparation, the apical thirds were serially sectioned and histologically processed. The cross-sections were examined by an optical microscope (X40) connected to a computer. The images were captured and analyzed using a computer software and submitted to morphometric analysis with aid of a grid. The percentage of debris remaining at the apical third was calculated. Data were submitted to statistical analysis by ANOVA and Tukey test. The results showed no statistically significant difference (p>0.01) between the groups irrigated with 1% NaOCl and 3.3% Ricinus communis detergent, which presented the lowest percentage of debris at the apical third, 8.49% and 10.11%, respectively. The group irrigated with distilled and deionized water had the highest percentage of debris (15.58%) and was statistically different from the other groups (p<0.01). It may be concluded that 3.3% Ricinus communis detergent and 1% NaOCl had similar cleaning effectiveness on removal of debris from root canals.

In vitro antimicrobial activity of acroseal, polifil and epiphany against Enterococcus faecalis

Using the agar diffusion method, this study evaluated the in vitro antimicrobial activity of the commercial endodontic sealers Acroseal and Epiphany, a castor-oil based experimental sealer, Polifil, and a primer agent (Epiphany self-etching primer), against Enterococcus faecalis. Zinc oxide and eugenol cement (ZOE) served as control. Five wells per dish were made at equidistant points and immediately filled with the test and control materials. After incubation of the dishes at 37ºC for 24 h and 48 h, the diameter of the zones of microbial growth inhibition produced around the wells was measured (in mm) with a millimeter rule. After 48 h, the diameters of the zones of microbial growth inhibition were the same as those observed at 24 h, only the substances continued to diffuse. Epiphany and Polifil did not show antibacterial activity (no formation of zones of microbial growth inhibition). The primer produced the largest zones of inhibition (17.62 mm) followed by Acroseal (7.25 mm) and ZOE (7.12 mm). E. faecalis was resistant to Epiphany and Polifil, while the primer and Acroseal sealer were effective against this microorganism under the tested conditions.

Use of phytotherapy in dentistry

Over the past decade, interest in drugs derived from medicinal plants has markedly increased. This study was aimed at a literature review focusing on studies investigating herbal drugs and other natural products, as well as their therapeutic application, side effects and possible drug interactions. Few studies were found to support their rational use in dentistry. Since there is an increasing use of phytotherapeutic agents in dentistry, further studies are needed to evaluate their safety and effectiveness for clinical use.

Loss of heterozygosity by mitotic recombination in diploid strain of Aspergillus nidulans in response to castor oil plant detergent

Somatic recombination in heterozygous diploid cells may be a promotional agent of neoplasms by inducing homozygosity of defective genes. Tumor suppressor genes may in this way be completely suppressed in recombinant cells. In this work, the genotoxic effects of detergent derived from the castor oil plant (Ricinus communis) in heterozygous diploid cells of Aspergillus nidulans are evaluated. Previous studies have evaluated the application of this substance in endodontic treatments as an irrigating solution. The recombinogenic potential of the compound has been studied through the production of homozygous cells for nutritional markers riboA1, pabaA124, biA1, methA17, and pyroA4. Detergent was diluted to 1:10, 1:20, and 1:40, and morphologic alterations, delay in conidiophore development, and mitotic recombination occurrence were reported for the three dilutions. Although past studies have demonstrated the antimicrobial action of the detergent under analysis, our results revealed its cytotoxic effects and recombinogenic potential.

Effect of 2% Chlorhexidine Gel as an Intracanal Medication on the Apical Seal of the Root-Canal System

The purpose of this study was to determine what effect intracanal medications might have on the apical seal of the root-canal system. Forty-two teeth were cleaned and shaped in a crown-down manner to a size #50 K-file. The teeth were divided into three groups: (A) immediate obturation; (B) intracanal placement of calcium hydroxide placed for 14 days; and (C) 2% chlorhexidine gel placed for 14 days. After 14 days, these materials were removed using copious irrigation and obturation was completed on groups B and C. Obturation was performed using the continuous wave of condensation technique using AH Plus sealer in all groups. Leakage was evaluated 60 days after obturation by using a fluid-filtration device. Using the one-way ANOVA test, there was no statistically significant difference in leakage between the three groups. Under the conditions of this study, 2% chlorhexidine gel and calcium hydroxide paste did not adversely affect the apical seal of the root-canal system.

Antibacterial Efficacy of Calcium Hydroxide and Chlorhexidine Gluconate Irrigants at 37°C and 46°C

This study investigated the ability of two endodontic irrigants to eliminate Enterococcus faecalis from dentinal tubules, and whether their antimicrobial action was enhanced by heat. The lumens of disks prepared from extracted bovine roots were infected with E. faecalis and incubated for 72 h. Specimens were then filled with saline, 10% calcium hydroxide (Ca(OH)2), or 0.12% chlorhexidine gluconate (CHX) at 24 degrees C or 46 degrees C and incubated at 37 degrees C or 46 degrees C. The samples were then pulverized and plated to quantify residual bacteria. No statistical difference (p > 0.05) in bacterial growth was seen between the two saline groups, or between the two medication groups at a given temperature. CHX and Ca(OH)2 at either temperature produced significantly less growth than either saline group, and CHX or Ca(OH)2 at 46 degrees C produced significantly less growth than either group at 37 degrees C. Heat enhanced the antibacterial action of both experimental irrigants against E. faecalis, but heating saline produced no increase in bactericidal effect.