Comparative Evaluation of Antimicrobial Efficiency of Various Herbal Root Canal Irrigants

Abstract

Introduction:

By reducing the bacterial load in root canals, irrigation contributes significantly to the disinfection of the root canal system.

Objectives:

The current research was done to assess antimicrobial efficiency of various herbal root canal irrigants against E. Faecalis.

Materials and Method:

Enterococcus faecalis, reference strain ATCC 19433, was combined and cultivated with root canal irrigating solutions containing sodium hypochlorite (NaOCl), triphala, turmeric, and garlic (Allium sativum). After being cultivated on bile auscline agar, the samples were incubated for 24 hours at 37°C. The colony-forming units (CFU) were calculated. A statistical analysis was performed on the collected data.

Result:

There was highest antimicrobial efficacy and greater reduction of CFU with group IV followed by groups II, I, and III. The difference was statically significant.

Conclusion:

Tested herbal irrigants were effective in reducing E faecalis count. They can be suggested to use alternative to NaOCl.

INTRODUCTION

Numerous studies have demonstrated that the main cause of pulpal and periapical disorders is bacteria and their byproducts. The quantity of bacteria in the root canal system is closely connected to the degree of pulpal and periapical inflammation.[1] Removing diseased tissue and preventing its recontamination are the mail objectives of endodontic treatment.[2] Microorganisms cannot be eliminated from inaccessible root canal locations by mechanical instruments and cleaning alone. Therefore, in addition to mechanical cleaning, root canal irrigants were recommended. Because they help clean the root canal, irrigating solutions are crucial during root canal preparation.[2] Enterococcus faecalis is the most common pathogenic microorganism in primary root canals. E. faecalis is able to endure in extremely alkaline environments.[3] Certain mechanical and chemical characteristics are necessary for an antibacterial irrigant to be effective. It must have low surface tension in order to reach difficult-to-reach places and be able to debride the canal and dissolve trash.[1] The optimum root canal irrigant should have a broad antimicrobial spectrum, the capacity to remove a smear layer, Systemically safe, non-irritating to periapical tissues, non-corrosive to periodontal tissues, and reasonably priced.[2]

Due to its lack of antibacterial qualities and inability to effectively clean dirty or necrotic wounds, saline is frequently employed as a control irrigant. Therefore, sodium hypochlorites and chlorhexidine are recommended. At therapeutic dosages, CHX has a slow, steady release and broad-spectrum antibacterial action.[1] The frequently used chemical in this process is sodium hypochlorite [NaOCl], which can be used in quantities ranging from 1 to 6%. NaOCl has a number of disadvantages, including toxicity, an unpleasant odour, and the inability to dissolve solely organic materials. As a result, several safe herbal irrigants such neem, green tea extract, turmeric, garlic, and aloe vera were explored.[2]

Triphala is an Indian ayurvedic herbal concoction made from the dried and powdered fruits of three medicinal plants: Terminalia chebula, Terminalia bellerica, and Emblica officinalis. The fruit of triphala has a lot of citric acid, which helps to remove the smear layer. Additionally, triphala may break down microbiological membranes. It is a good alternative to sodium hypochlorite because of its chelating properties.[2]

An Indian spice and traditional remedy is curcuma longa, or turmeric. Curcumin is the primary component in turmeric. Turmeric has anti-inflammatory, anti-cancer, antibacterial, and antioxidant properties. Both gramme positive and gramme negative bacteria are susceptible to its phototoxic effects. Additionally, it possesses antibacterial properties against Enterococcus faecalis and Staphylococcus aureus.[2,3]

Garlic (Allium sativum), is used to boost immunity against coughing and colds. Diallyl sulphide (allicin), which is similar to penicillin, is the main ingredient. Allicin, which is found in garlic, acts as an alternate irrigant to NaOCl by destroying the root canal bacteria’s cell membrane.[2]

The current research was done to assess antimicrobial efficiency of various herbal root canal irrigants.

MATERIALS AND METHOD

This in vitro research was done in Pediatric dentistry Department. Group I: Curcuma longa (turmeric), Group II: triphala, Group III: Allium sativum (garlic), and Group IV: sodium hypochlorite (NaOCl) root canal irrigating solutions were combined and used to cultivate E. faecalis using reference strain ATCC 19433. After being cultivated on bile auscline agar, the samples were incubated for 24 hours at 37°C. The colony-forming units were counted. The obtained data was statically evaluated using ANVA test at P < 0.005.

RESULT

Table 1 indicates highest antimicrobial efficacy and greater reduction of colony forming units (CFU) with group IV followed by groups II, I, and III. The difference was statically significant (P < 0.05).

Table 1.

Comparison for Reduction of bacteria colony forming units among groups

Groups	Mean±SD	F	P
Group I - Curcuma longa	−20.43	2.68	0.05*
Group II - Triphala	−20.63
Group III - Allium sativum	−20.13
Group IV - NaOCl	−23.45

*Significant

DISCUSSION

Complete pulp tissue extraction from the crown and radicular canals is required for pulpectomy in primary teeth. Following root canal cleaning and shape, the canals are obturated using a suitable resorbable material.[4] The primary cause of periapical and pulpal disorders is bacteria.[1] Proper instrumentation, irrigation, and root canal obturation are essential components of successful root canal therapy because they eliminate the smear layer and root canal infections.[4]

In the current research we found antibacterial efficiency of various herbal root canal irrigants. These irriganta can be suggested to use alternative to sodium hypochlorite.

Through a clinical trial, Elmenbawy et al.[4] evaluated the antibacterial effectiveness of NaOCl, 3.8% silver diamine fluoride (SDF), and extract of propolis as root canal irrigants for primary teeth. After irrigation, they found that propolis had the greatest bactericidal effect, significantly reducing the number of bacterial growths.

The antibacterial effectiveness of saline, 0.5% and 2% essential oils of Zataria multiflora (Z. multiflora), 0.5% and 2% essential oils of Mentha piperita (M. piperita), and 0.2% chlorhexidine (CHX) as root canal irrigants for primary molar teeth was compared by Pordel et al.[1] They discovered that 0.5% Z. multiflora essential oil and 2% M. piperita essential oil had the best antibacterial action against E. faecalis. Shalan et al.[3] discovered that all tested herbal irrigation solutions (propolis and turmeric) were effective in eliminating E. faecalis.

According to Aly et al.,[5] when used as a root canal irrigant for primary teeth, chamomile had a stronger antibacterial impact than propolis and both shown an antimicrobial effect that was lower than chlorohexidine and effective against Enterococcus faecalis. Vathsala et al.[6] evaluated the antibacterial activity of many herbal root canal irrigants against E. faecalis, including turmeric, green tea, neem (Azadiracta indica), and triphala. They came to the conclusion that the herbal irrigants they tested were effective against E. faecalis bacteria. These natural irrigants are therefore a substitute for sodium hypochlorite. The outcomes align with our findings. Among the herbal extracts, Noushad et al.[7] discovered that guava leaf extract and cashew apple extract had statistically significant effectiveness against Candida albicans and E. faecalis.

NaOCl is a popular irrigant of choice with numerous benefits, including a bactericidal impact, albumin denaturation, low viscosity that makes it easy to introduce into the canal, and affordability. Alternative safe herbal irrigants with antibacterial effectiveness were proposed because NaOCl has numerous drawbacks.[4]

CONCLUSION

Tested herbal irrigants were effective in reducing E faecalis count. They can be suggested to use alternative to NaOCl.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.