Antibacterial and smear layer removal capability of oregano extract solution

Botanicals as promising antimicrobial agents for enhancing oral health: a comprehensive review

The mouth houses the second largest diversity of microorganisms in the body, harboring more than 700 bacterial species colonizing the soft mucosa and hard tooth surfaces. Microbes are the cause of several health-related problems, such as dental carries, gingivitis, periodontitis, etc., in the mouth across different age groups and socioeconomic/demographic groups. Oral infections are major health problems that affect the standard of living. Compromised oral health is related to chronic conditions and systemic disorders. Microbes responsible for dental caries are acid-producing and aciduric Gram-positive bacteria (Streptococci, Lactobacilli). Gram-negative bacteria (Porphyromonas, Prevotella, Actinobacillus, and Fusobacterium) capable of growing in anaerobic environments are responsible for periodontal diseases. Due to the high prevalence of oral diseases, negative effects associated with the use of antimicrobial agents and increased antibiotic resistance in oral pathogens, suitable alternative methods (effective, economical and safe) to suppress microbes disturbing oral health need to be adopted. Side effects associated with the chemical antimicrobial agents are vomiting, diarrhea and tooth staining. Several researchers have studied the antimicrobial properties of plant extracts and phytochemicals and have used them as indigenous practices to control several infections. Therefore, phytochemicals extracted from plants can be suitable alternatives. This review focuses on the various phytochemical/plant extracts suppressing the growth of oral pathogens either by preventing their attachment to the surfaces or by preventing biofilm formation or other mechanisms.

Antimicrobial efficacy of natural-based endodontic solutions: a systematic review with a network meta-analysis

This systematic review aims to provide preclinical evidence of the antimicrobial efficacy of natural endodontic solutions (NES) compared to sodium hypochlorite (NaOCl) and chlorhexidine (CHX) against Enterococcus faecalis. The study followed the PRISMA guidelines and had a registered protocol (PROSPERO - CRD42021224022). The inclusion criteria comprised ex vivo studies simulating root canal irrigation to assess the standardized mean difference of colony-forming units (CFUs). Records were systematically identified in PubMed, Scopus, EMBASE, SciELO, Web of Science, LILACS, DANS Easy, and BDTD databases in January 2024. The RoBDEMAT tool helped determine the risk of bias. As for the network meta-analysis, CFU data were collected pre- and post-irrigation protocols as an effect measure. Thirty-five studies met the eligibility criteria and were included in the qualitative analysis, and seven studies were eligible for the network meta-analysis. The total sample consisted of 1,504 root canals. Among the tested solutions, apple cider vinegar combined with 2.5% NaOCl showed the highest probability of reducing CFUs after root canal irrigation (95%CI: -0.76-0.20), followed by 2% CHX and NaOCl (considering the different concentrations [95%CI: -0.32-0.17]). The bias assessment revealed significant omissions in reporting, particularly regarding sample size calculation, sample randomization, and operator blinding. The obtained evidence demonstrated that, even though NES did not overcome NaOCl, they have antimicrobial potential against Enterococcus faecalis.

In Vitro Evaluation of Smear Layer and Debris Removal and Antimicrobial Activity of Different Irrigating Solutions

OBJECTIVE

The aim of this in vitro study was to compare the smear layer and debris removal and antimicrobial activity of two dual-action irrigating solutions for continuous chelation (Triton; Brasseler, Savannah, USA and Dual Rinse HEDP; Medcem GmbH, Weinfelden, Switzerland) with a dual step irrigation protocol with sodium hypochlorite (NaOCl) followed by ethylenediaminetetraacetic acid (EDTA).

METHODS

Thirty single-rooted single-canal teeth were divided into three groups (n=10) and irrigated with Triton, Dual Rinse HEDP mixed with 6% NaOCl and 6% NaOCl/17% EDTA. The teeth were observed under a scanning electron microscope (SEM) to assess the canal wall cleanliness. In addition, 80 dentine discs were contaminated with Candida albicans and 80 discs with Enterococcus faecalis and irrigated with Triton, Dual Rinse HEDP mixed with 6% NaOCl and 6% NaOCl/17% EDTA or not treated (n=20). Fifteen discs were used to evaluate colony-forming units, while 5 discs were analysed by SEM. Data were analysed using the Shapiro- Wilk, Kruskal-Wallis and One-Way ANOVA tests.

RESULTS

Triton was statistically more effective than Dual Rinse HEDP and NaOCl/EDTA in removing debris (p<0.05), except with NaOCl/EDTA in the coronal third. Triton was more effective than Dual Rinse HEDP in removing the smear layer from the apical and middle thirds (p<0.05). All the irrigation protocols significantly re- duced the number of E. faecalis. The Triton group showed the lowest number of remaining C. albicans (p<0.05).

CONCLUSION

Triton was the most effective irrigation solution in removing debris and as effective as NaOCl/ EDTA in removing the smear layer. Triton showed the highest efficacy against C. albicans. New irrigating solutions that provide continuous chelation may provide an alternative to current irrigation protocols.

Effect of Passion Fruit Juice in Removal of Smear Layer in Root Canal of Ex Vivo Human Teeth: A Scanning Electron Microscopic Study

CONTEXT

The smear layer produced during the instrumentation of the root canal contains both organic and inorganic components, and it is recommended to be removed as it has a mixture of bacteria and their byproducts. Irrigants like sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA), endodontic irrigant, citric acid, etc., possess the ability to remove the smear layer. Considering the antimicrobial effect, antiinflammatory, cavity disinfectant, nontoxicity, better taste, and aroma of herbal products, a novel approach has been introduced in the field of endodontics.

AIMS

To assess the efficacy of passion fruit juice in removing the smear layer and its erosive potential in root canals after instrumentation by scanning electron microscopy.

MATERIALS AND METHODS

About 35 single-rooted premolars were divided into five groups-30% passion fruit extract (PFE), 17% EDTA, 17% EDTA + 5.25% NaOCl, 30% PFE + 17% EDTA, and saline. Following irrigation with the above irrigants, each tooth was split into two halves and examined and scored for smear layer removal (modified Torabinejad's criteria) using a scanning electron microscope.

STATISTICAL ANALYSIS

Overall comparison of the irrigant's action on removing the smear layer and their erosive potential was done using the Kruskal-Wallis test, and intergroup comparison of the irrigant action was done using the Mann-Whitney U test. All the statistical analyses were set with a significance level of p < 0.05.

RESULTS

A total of 30% PFE produced less erosion and statistically significant smear layer removal in the coronal and middle third of the root. When combined with 17% EDTA, it effectively removed the smear layer in all three-thirds of the root. Around 30% PFE + 17% EDTA is less erosive when compared to 17% EDTA + 5.25% NaOCl.

CONCLUSION

This study revealed that 30% PFE and 30% PFE + 17% EDTA are promising irrigants as root canal disinfectants in endodontics.

HOW TO CITE THIS ARTICLE

Venkatachalamoorthi V, Shivashankarappa PG, Adimoulame S, et al. Effect of Passion Fruit Juice in Removal of Smear Layer in Root Canal of Ex Vivo Human Teeth: A Scanning Electron Microscopic Study. Int J Clin Pediatr Dent 2023;16(S-2):S190-S194.

Scanning Electron Microscopy Analysis of Smear Layer Removal Ability of Conventional Endodontic Irrigation Regimen, MTAD, and QMix™ Versus a Mixture of Azadirachta indica and Citrus limon: An In Vitro Study

INTRODUCTION

Smear layer removal from root canals aid in the penetration of both irrigants and endodontic sealer into the dentinal tubules, thereby improving the efficacy of endodontic treatment. The aim of this in vitro study was to compare the smear layer removal ability of a conventional endodontic irrigation regimen, MTAD (mixture of tetracycline, acid, and detergent), and QMix™ (Dentsply Sirona, Charlotte, North Carolina, United States) with that of a mixture of herbal irrigants, namely, aqueous extracts of Azadirachta indica (neem) and Citrus limon (lemon), evaluated using scanning electron microscopy (SEM).

MATERIALS AND METHODS

We selected 40 extracted human premolar teeth for the study, which we randomly divided into five groups (eight samples each) according to irrigation solution: (i) Group A (normal saline); (ii) Group B (conventional endodontic regimen, 3% sodium hypochlorite (NaOCl) + 17% ethylenediamine tetraacetic acid (EDTA) + 2% chlorhexidine (CHX)); (iii) Group C (MTAD); (iv) Group D (QMix 2-in-1); and (v) Group E (aqueous extracts of Azadirachta indica and Citrus limon). After we prepared the canals with ProTaper Universal nickel-titanium (Ni-Ti) rotary files (Dentsply Sirona) and the respective irrigants, we split the teeth longitudinally to evaluate the amount of remnant smear layer in the coronal, middle, and apical thirds using SEM photomicrographs. We performed statistical analyses of the data using the Kruskal-Wallis and Mann-Whitney U tests, where the level of significance was set at 0.05.

RESULTS

The SEM analysis of the coronal third showed mean values of 3.83 in Group A, 3.67 in Group B, 2.79 in Group C, 3.63 in Group D, and 4.00 in Group E. The SEM analysis of the middle third showed mean values of 4.00 in Group A, 3.88 in Group B, 3.75 in Group C, 3.50 in Group D, and 3.50 in Group E. The SEM analysis of the apical third showed mean values of 3.92 in Group A, 3.63 in Group B, 3.71 in Group C, 3.88 in Group D, and 3.17 in Group E. Therefore, we found that there were significant statistical differences between the groups when an overall comparison was done for the coronal, middle, and apical third, with a p-value of 0.001. On multiple comparisons across the different tooth-section thirds. Groups A and B showed statistically significant differences in the apical third (p-value=0.017). Groups A and C showed statistically significant differences in the coronal third and middle third (p-values=0.001 and 0.010, respectively). Groups A and D showed statistically significant differences in the middle third (p-value=0.001). Groups A and E showed statistically significant differences in all thirds (p-values=0.039, 0.001, and 0.001, respectively) Conclusion: The conventional needle irrigation with MTAD showed the highest level of smear layer removal ability on the root canal surface, followed by QMix 2-in-1, the Azadirachta indica leaf and Citrus limon extract mixture, and the conventional endodontic regimen. Normal saline showed the lowest smear layer removal effect.

The Role of Natural Compounds in Optimizing Contemporary Dental Treatment-Current Status and Future Trends

For a long period of time, natural remedies were the only ailment available for a multitude of diseases, and they have proven effective even after the emergence of modern medicine. Due to their extremely high prevalence, oral and dental disorders and anomalies are recognized as major public health concerns. Herbal medicine is the practice of using plants with therapeutic characteristics for the purpose of disease prevention and treatment. Herbal agents have made a significant entry into oral care products in recent years, complementing traditional treatment procedures due to their intriguing physicochemical and therapeutic properties. There has been a resurgence of interest in natural products because of recent updates, technological advancements, and unmet expectations from current strategies. Approximately eighty percent of the world's population uses natural remedies, especially in poorer nations. When conventional treatments have failed, it may make sense to use natural drugs for the treatment of pathologic oral dental disorders, as they are readily available, inexpensive, and have few negative effects. The purpose of this article is to provide a comprehensive analysis of the benefits and applications of natural biomaterials in dentistry, to gather relevant information from the medical literature with an eye toward its practical applicability, and make suggestions for the directions for future study.

Herbal Agents versus Ethylene Diamine Tetra Acetic Acid on Removal of the Smear Layer-A Systematic Review of In Vitro Studies

This systematic review aimed to compare the efficacy of herbal agents with ethylene diamine tetraacetic acid (EDTA) in removing the smear layer during root canal instrumentation. The research question in the present study was to assess: "Is there a significant difference in reducing smear layer comparing EDTA and herbal agents?" Electronic databases (PubMed, Scopus, and Web of Science) were searched from their start dates to April 2022 using strict inclusion and exclusion criteria, and reviewed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Only in vitro studies comparing herbal agents with EDTA were included in the current systematic review. Two reviewers independently assessed the included articles. A total of 625 articles were obtained from an electronic database. Eighteen papers were included for review of the full text, out of which, ten papers were excluded because they did not meet the inclusion criteria. Finally, eight articles were included in the systematic review. The present systematic review considered only in vitro studies; hence, the result cannot be completely translated to strict clinical conditions. The results of the present systematic review have shown that quixabeira, morindacitrifolia, oregano extract, and neem show better smear layer removal compared to other herbal agents, whereas they showed reduced smear layer removal when compared with EDTA. Although, it was seen that most of the included studies did not report a high quality of evidence. Hence, the present systematic review concludes that herbal agents have reported to show inferior smear layer removal when compared to EDTA. Thus, as far as herbal based alternatives are concerned, there is no highest level of evidence to state its real benefit when used as a chelating root canal irrigant.

Herbal Medications in Endodontics and Its Application-A Review of Literature

Herbal products are gaining popularity in dental and medical practice nowadays due to their biocompatibility, higher antimicrobial activity, antioxidant and anti-inflammatory properties. Herbal medicine has experienced rapid growth in recent years due to its beneficial properties, ease of availability, and lack of side effects. As pathogenic bacteria become more resistant to antibiotics and chemotherapeutic agents, researchers are becoming more interested in alternative products and treatment choices for oral diseases. As a result, natural phytochemicals separated from plants and utilized in traditional medicine are suitable substitutes for synthetic chemicals. The aim of this review article is to list and understand several herbal alternatives that are currently accessible for use as efficient endodontic medicaments. The herbal products used in endodontics have several advantages, including safety, ease of use, increased storability, low cost, and a lack of microbial tolerance. However, preclinical and clinical testing and interactions with other materials and adverse effects are required for these herbal products.

Comparison of Herbal Agents with Sodium Hypochlorite as Root Canal Irrigant: A Systematic Review of In Vitro Studies

During endodontic treatment, eliminating microorganisms from the root canals should be considered with utmost importance. Before filling the canal, every effort should be made to ensure optimal shaping and adequate disinfection of the root canal system. This systematic review aimed to compare the efficacy of herbal agents with sodium hypochlorite (NaOCl) in reducing the microbial load while used as a root canal irrigant. The research question in the present study was to assess “Is there a significant difference in reducing microbial load comparing sodium hypochlorite (NaOCl) and herbal agents.” Electronic databases (PubMed, Scopus, and Web of Science) were searched from their start dates to November 2020 using strict inclusion and exclusion criteria and reviewed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Only in vitro studies comparing herbal agents with NaOCl regarding antimicrobial efficiency were included. Two reviewers independently assessed the included article. 825 articles were obtained from an electronic database. Twenty papers were included for review of the full text. Eleven papers were excluded because they did not meet the inclusion criteria. Finally, nine articles were included in the systematic review. The present systematic review was at the in vitro level; therefore, the result cannot translate the exact clinical conditions. This systematic review concludes that herbal agents cannot be used as a main irrigant for canal disinfection.

Essential Oils as Alternatives for Root-Canal Treatment and Infection Control against Enterococcus faecalis—A Preliminary Study

Since natural alternatives are needed in dentistry for the treatment of root canal, where the standard irrigant is NaOCl with significant toxicity, the aim of the study was to assess the antibacterial properties of non-chemical root-canal irrigants (aqueous extracts of oregano, thyme, lemongrass, melaleuca and clove essential oils) against Enterococcus faecalis. For this, aqueous extracts of each essential oil (AqEO) were prepared. A solution of sodium hypochlorite (NaOCl) was used as a positive standard against which the antimicrobial effects of AqEO could be reported. The root canals of seven teeth were inoculated with 20 µL of Enterococcus faecalis ATCC29212 inoculum and incubated overnight at 37 °C. All the teeth canals were instrumented and were irrigated with the corresponding AqEO, NaOCl and saline solution, then rinsed with saline. Bacteriological samples for each canal post-instrumentation were collected with sterile paper points which were inoculated on culture media. A second processing followed the same methodology but involved only irrigation and no instrumentation. Using instrumentation, thyme and clove completely inhibited Enterococcus faecalis growth. Without instrumentation, clove and oregano AqEOs completely reduced the bacterial load as seen in direct inoculation, but bacterial growth was observed in all the samples after enrichment, except for NaOCl. Nevertheless, the turbidity of the enrichment media was lower for the samples irrigated with AqEOs than for control. In conclusion, AqEOs of thyme, oregano and clove showed a promising antibacterial effect, especially when teeth instrumentation was performed.

Natural products in endodontics

Herbal remedies are used throughout the world, either in earlier or in recent times. The number of studies on this alternative therapeutic system increased in the last decades. In this paper, the relevant literature on the use of natural products in root canal therapy is revised from a MEDLINE database search. The uses of medicinal plants in endodontics include cleaning and disinfection of root canals, intracanal medicaments between appointments, sealer cements, and for removal of obturation material. Other studies showed the effect of natural products in pulpal and dentin repair. Their use is anecdotal, and their effectiveness showed to be variable and is always compared to the chemical standards currently being used. Alkaloids, coumarins, saponins, and flavonoids are aromatic substances that are produced by plants and evaluated for their therapeutic potential. Further investigation into benefits of natural products is warranted.

Effectiveness of Persea major Kopp (Lauraceae) extract against Enterococcus faecalis: a preliminary in vitro study

Background

Persea major Kopp (Lauraceae) is a plant with wound healing, antibacterial, and analgesic properties. The aim of this study was to assess the in vitro antibacterial activity of the concentrated crude extract (CCE) and ethyl acetate fraction (EAF) of this plant against Enterococcus faecalis and compare it with calcium hydroxide [Ca(OH)₂] paste and 2% chlorhexidine digluconate (CHX).

Methods

The plant material was collected, and an extract was prepared according to the requirements of the study (CCE and EAF). The minimum inhibitory concentrations (MICs) of CCE, EAF, Ca(OH)₂, Ca(OH)₂ + CCE, and CHX against E. faecalis were determined using the broth microdilution method

Results

The EAF inhibited E. faecalis at concentrations of 166.50, 83.25, and 41.62 mg mL⁻¹, and 1.00, 0.50, and 0.25% of CHX solutions showed antimicrobial activity. The MICs of Ca(OH)₂ paste were 166.50 and 83.25 mg mL⁻¹, whereas Ca(OH)₂ + CCE showed antimicrobial activity only at a concentration of 166.50 mg mL⁻¹. CCE showed no inhibitory effect at any of the concentrations tested

Conclusions

The CCE did not show any antimicrobial activity against E. faecalis; however, the EAF was the most effective among the three highest concentrations tested.

Chemical composition and antioxidant activities of essential oils from different parts of the oregano

This research was undertaken in order to characterize the chemical compositions and evaluate the antioxidant activities of essential oils obtained from different parts of the Origanum vulgare L. It is a medicinal plant used in traditional Chinese medicine for the treatment of heat stroke, fever, vomiting, acute gastroenteritis, and respiratory disorders. The chemical compositions of the three essential oils from different parts of the oregano (leaves-flowers, stems, and roots) were identified by gas chromatography-mass spectrometry (GC-MS). The antioxidant activity of each essential oil was assessed using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging assay and reducing the power test. Among the essential oils from different parts of the oregano, the leaf-flower oils have the best antioxidant activities, whereas the stem oils are the worst. The results of the DPPH free radical scavenging assay showed that the half maximal inhibitory concentration (IC₅₀) values of the essential oils were (0.332±0.040) mg/ml (leaves-flowers), (0.357±0.031) mg/ml (roots), and (0.501±0.029) mg/ml (stems), respectively. Interestingly, the results of reducing the power test also revealed that when the concentration exceeded 1.25 mg/ml, the leaf-flower oils had the highest reducing power; however, the stem oils were the lowest.