In vitro evaluation of different chemical agents for the decontamination of gutta-percha cones

Efficacy of calcium hypochlorite in disinfection of gutta-percha cones contaminated with Candida albicans

This study aimed to compare the efficacy of 2.5% sodium hypochlorite (NaOCl), 2.5% calcium hypochlorite [Ca(OCl)2], and 2% chlorhexidine (CHX) in the rapid disinfection of gutta-percha cones contaminated with Candida albicans. The minimum inhibitory and minimum fungicidal concentrations of each solution for C. albicans were determined and the ability of each solution to destroy and inhibit biofilm in culture wells was tested. In addition, ninety-eight gutta-percha cones contaminated with the fungal suspension were disinfected according to the type of solution (2.5% NaOCl, 2.5% Ca(OCl)2 or 2% CHX) in its different application methods (without agitation, ultrasonic agitation or agitation with Easy Clean), and regarding the exposure time to each irrigating solution (1 or 5 min). Next, the samples were checked for turbidity and evaluation of viable colonies. The compounds that showed the best performance in biofilm destruction were NaOCl and Ca(OCl)2 at a concentration of 2xMIC (p < 0.001). Regarding inhibited biofilm, the only compound that was effective at all MIC concentrations tested was 2.5% Ca(OCl)2 (p < 0.0001). Regarding the viable colonies, all solutions were effective concerning the control group, for all application methods, in 1 and 5 min (p < 0.05). The densitometer reading showed that CHX was the only effective solution in all application methods performed (p < 0.05). The results demonstrate that all tested solutions were effective in the rapid decontamination of cones contaminated with C. albicans.

Management of Instrument Sterilization Workflow in Endodontics: A Systematic Review and Meta-Analysis

Endodontic treatment consists of different working procedures, such as the isolation of the operating field, pulp chamber access, and cleaning and shaping phases with at last the need of a three-dimensional filling of the canals. Each step requires a series of single-use or sterilizable instruments. We have performed a systematic review of different sterilization and disinfection procedures aiming at drawing up a disinfection and sterilization procedure to be used on endodontic instruments. A search on PubMed and Scopus was carried out using the following keywords: “endodontic sterilization,” “endodontic autoclave,” “decontamination dental bur,” “sterilization dental burs,” and “gutta-percha points sterilization.” Eligible articles were included in the qualitative and quantitative analysis. Results of the meta-analysis showed that the most effective method in sterilization is autoclaving. The qualitative analysis showed that the use of single-use or first-use instruments requires presterilization or sterilization procedures, and for reusable tools, attention must be paid to the removal of debris deposited on the blades, not easy to remove manually.

Disinfection and surface changes of gutta-percha cones after immersion in sodium hypochlorite solution containing surfactant

In this study, we evaluated the effectiveness of 1 and 5.25% NaOCl solutions, with or without surfactant, in disinfecting gutta-percha cones. Surface changes of the gutta-percha cones after disinfection were also assessed under scanning electron microscopy (SEM). One-hundred and eight gutta-percha cones previously contaminated with Enterococcus faecalis were left in contact for 30 s or 1 min with the following solutions (n = 12): 1% NaOCl; 1% NaOCl + 2% cetrimide; 5.25% NaOCl; 5.25% NaOCl + 2% cetrimide. Positive control group was composed by the remaining contaminated cones (n = 12), and the negative control group by noncontaminated cones (n = 12). The cones were kept in Eppendorf tubes containing Trypticase Soy Broth at 37°C for 24 hr, and then, the presence of turbidity was analyzed. Ten additional cones (n = 2) were observed under SEM to evaluate surface changes after 1 min of disinfection. The data analysis (Kruskal-Wallis test, α = 5%) demonstrated that regardless the presence of surfactant, the NaOCl solutions used were effective in the disinfection when cones were immersed for 1 min. However, at the 30-s period, only the 5.25% NaOCl solution was effective. SEM analysis demonstrated that NaOCl solutions promoted the formation of sodium chloride crystals on cones surface, less visible when the 1% NaOCl associated to surfactant was used. The addition of surfactant did not affect the disinfection capacity of NaOCl solutions. However, the surfactant has apparently inhibited the sodium chloride crystals deposition on the cones surface when associated to 1% NaOCl solution.

Avaliação das soluções de Clorexidina e de Hipoclorito de Sódio na descontaminação de cones de guta percha contaminados por Enterococcus faecalis

O objetivo deste trabalho foi avaliar a efetividade das soluções de Clorexidina e do Hipoclorito de Sódio na descontaminação de cones de guta percha. O estudo foi realizado em duplicata, e em cada um dos testes cones de guta percha #40 foram utilizados. 24 cones foram contaminados com Enterococcus faecalis. Os cones contaminados foram divididos em grupos, conforme a solução (Clorexidina a 2%, Clorexidina a 0,2% e Hipoclorito de Sódio a 2,5%) e o tempo para a descontaminação (15, 30 e 60 segundos, 2, 5 e 10 minutos). Para o controle positivo, 6 cones foram contaminados e imersos em água destilada, pelo mesmo tempo dos tratamentos. Para o controle negativo, 6 cones foram retirados da caixa lacrada sem serem contaminados ou descontaminados. Após a desinfeção, os cones foram lavados e introduzidos em tubos de ensaio contendo caldo BHI e levados a estufa bacteriológica a 37º por 48 horas. Após, os tubos de ensaio foram analisados a partir do crescimento bacteriano e feito o plaqueamento em agar cromogênico. Os resultados demonstraram que a solução de Clorexidina a 0,2% não foi eficaz na descontaminação dos cones de guta percha em nenhum tempo estudado; a Clorexidina a 2% foi eficaz na descontaminação de cones em 10 minutos e que o Hipoclorito de Sódio foi eficaz a partir dos 60 segundos. Concluiu-se que o Hipoclorito de Sódio a 2,5% foi a solução que descontaminou os cones de guta percha no menor tempo.

Practical use of povidone-iodine antiseptic in the maintenance of oral health and in the prevention and treatment of common oropharyngeal infections

AIMS

To better inform medical practitioners on the role of antiseptics in oropharyngeal health and disease, this article focuses on povidone-iodine (PVP-I), an established and widely-available antiseptic agent.

METHODOLOGY

Review of the anti-infective profile, efficacy and safety of PVP-I in managing common upper respiratory tract infections such as the common cold, influenza and tonsillo-pharyngitis, as well as oral complications resulting from cancer treatment (oral mucositis), and dental conditions (periodontitis, caries).

RESULTS

Antiseptics with broad-spectrum anti-infective activity and low resistance potential offer an attractive option in both infection control and prevention. While there is some evidence of benefit of antiseptics in a variety of clinical settings that include dental and oral hygiene, dermatology, oncology, and pulmonology, there appears to be discordance between the evidence-base and practice. This is especially apparent in the management and prevention of oropharyngeal infections, for which the use of antiseptics varies considerably between clinical practices, and is in marked contrast to their dermal application, where they are extensively used as both a prophylaxis and a treatment of skin and wound infections, thus minimising the use of antibiotics.

CONCLUSION

The link between oral and oropharyngeal health status and susceptibility to infection has long been recognised. The high rates of antibiotic misuse and subsequent development of bacterial resistance (e.g. increasing vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA)) in large parts of the world, especially across Asia Pacific, highlight the need for identifying alternative antimicrobials that would minimise the use of these medications. This, together with recent large-scale outbreaks of, for example, avian and swine influenza virus, further underline the importance of an increasing armamentarium for infection prevention and control.

Biofilm forming capacity of Enterococcus faecalis on Gutta-percha points treated with four disinfectants using confocal scanning laser microscope: An in vitro study

Background:

The aim of this study was to evaluate and compare the in vitro biofilm forming capacity of Enterococcus faecalis on Gutta-percha points disinfected with four disinfectants.

Materials and Methods:

A total of 50 Gutta-percha points used in this study were divided into four test groups based on disinfectant (5.25% sodium hypochlorite, 2% chlorhexidine gluconate, 20% neem, 13% benzalkonium chloride [BAK]), and one control group. The Gutta-percha points were initially treated with corresponding disinfectants followed by anaerobic incubation in Brain Heart Infusion broth suspended with human serum and E. faecalis strain for 14 days. After incubation, these Gutta-percha points were stained with Acridine Orange (Sigma – Aldrich Co., St. Louis, MO, USA) and 0.5 mm thick cross section samples were prepared. The biofilm thickness of E. faecalis was analyzed quantitatively using a confocal scanning laser microscope. Results statistically analyzed using analysis of variance. P < 0.05 was considered to be significant.

Results:

Confocal scanning laser microscope showed reduced amount of E. faecalis biofilm on Gutta-percha points treated with BAK and sodium hypochlorite. Post-hoc (least square differences) test revealed that there is no statistically significant difference between BAK and sodium hypochlorite groups (P > 0.05).

Conclusion:

This study illustrates that the Gutta-percha points disinfected with sodium hypochlorite and BAK showed minimal biofilm growth on its surface.

Evaluation of antimicrobial efficacy of Aloe vera and its effectiveness in decontaminating gutta percha cones

Aim:

The aim of this study was to evaluate the antimicrobial efficacy of Aloe vera and to determine its effectiveness in decontaminating gutta percha cones.

Materials and Methods:

A concentrated extract of Aloe vera was used to check for the antimicrobial efficacy using the agar well diffusion method. Presence of zones’ of diffusion was identified against three common GP contaminants namely, E.coli, E.faecalis and Staph. aureus. New GP Cones, freshly taken out of the packet were then decontaminated for 1minute using Aloe vera gel and then placed in thioglycolate broth to check for the presence of turbidity.

Results:

The zones of inhibition on the agar plate were measured as 24mm,21mm and 24mm respectively. The broth remained clear even after 48 hours of incubation.

Conclusion:

We conclude that Aloe vera is indeed effective as a GP decontaminant and it holds a promising future as a medium for storage of GP cones.

Dissolving efficacy of some organic solvents on gutta-percha

The aim of this study was to evaluate the solubility of gutta-percha in four organic solvents used in endodontics. The solubility of gutta-percha (Dentsply) was assessed in xylol, orange oil, eucalyptol, chloroform and distilled water. A hundred and fifty samples of gutta-percha were prepared using a standardized stainless steel mould and divided into five groups for immersion in the different solvents tested and in distilled water (control group) for 2, 5 and 10 minutes. The means of gutta-percha dissolution in the solvents were obtained by the difference between the pre-immersion original weight and the post-immersion weight in a digital analytical scale (Gehaka - AG2000). Data were statistically analyzed by Analysis of Variance (ANOVA) and multiple comparisons with Scheffe’s test (p < 0.05). The best solvency capacity was obtained with xylol. Chloroform, orange oil and eucalyptol presented similar results, and distilled water did not promote alterations in the gutta-percha.