A proposed classification system for herbal endodontic irrigants

Abstract

Irrigating solutions are an essential adjunct in the root canal therapy for the complete disinfection of the root canal space. The recent trend focuses on the use of herbal extracts in endodontics owing to their advantages and minimal side effects. In view of this, we have proposed a classification system to classify herbal endodontic irrigants as currently, there is no standard classification available. This structured classification will give an overview of the diversity of herbal irrigants and also highlight the potential use of each of them. Thus, it will be easy to segregate the study and use the herbal endodontic irrigants according to the requirements. The proposed classification system shall prove to be highly beneficial to the students, researchers, and clinicians.

INTRODUCTION

The success of endodontic therapy is multifactorial, starting from the preparation of access cavity, biomechanical preparation followed by three-dimensional obturation of the root canal system. The intricacies of the root canal have been found to accommodate persistent biofilms in teeth. Thus, the primary goal of endodontic treatment must be to accomplish root canal disinfection, thus preventing re-infection. The use of chemical substances along with mechanical instrumentation as an aid for the disinfection and removal of necrotic tissue from the root canal space has been a constitutive part of endodontic therapy.

An ideal endodontic irrigant should possess the ability to dissolve pulp tissue, collagen, remove biofilm, and to remove the smear layer. It should be nontoxic or carcinogenic to the peripheral tissue cells of the tooth, show no deleterious effect on the sealing abilities of sealers, exhibit no irritation to the periapical tissues and should be easily available.

Sodium hypochlorite has been the most extensively used root canal irrigant due to its exemplary properties. However, it is associated with several undesirable characteristics such as allergic potential, tissue toxicity, risk of emphysema when extruded, disagreeable smell/taste, and inability to remove the smear layer. Other irrigants commonly used in endodontics such as chlorhexidine, ethylene-diamine-tetra-acetic acid, citric acid, etc., are also associated with side effects such as tooth discoloration and reduction in the microhardness of root dentin.

India is famous for its rich heritage of traditional medicinal systems. With herbal remedies and holistic medicine gaining increasing popularity among the public, over the past decade, there has been a paradigm shift toward the usage of phytochemicals in the field of Endodontics. Herbal endodontic irrigants have advantages such as high antimicrobial activity, anti-inflammatory, antiseptic and anti-oxidant properties, biocompatibility, ease of availability, cost effectivity, less toxicity, less or no staining of teeth such as in cases of synthetic irrigating solutions and decreased microbial resistance against Enterococcus faecalis.

NEED FOR CLASSIFICATION

Extensive research has been carried out exploring the diversity of herbs to be used as endodontic irrigants. However, to the best of authors' knowledge, there is no specific classification allocating them into different groups. A systematic classification will be helpful for the students to comprehend and remember the properties of herbal irrigants. It can give a detailed overview of the diversity of herbal endodontic irrigants and can also help to understand the properties, similarities, and dissimilarities between the different irrigants. It will help the researchers to select the herbal irrigants for undertaking a study. This classification will also prove beneficial to the clinicians or practitioners as they can easily segregate specific irrigants depending on their need in the clinical practice.

Basis of classification

The most important properties an ideal root canal irrigant should possess include antimicrobial property, chelating ability, and ability to dissolve the pulp tissue. Various studies have shown that herbal irrigants may possess one or more of these properties. In the proposed classification system, the herbal irrigants have been classified based on these properties [Figure 1]. The proposed classification system has been registered by the Copyright Office of India (Registration Number: L-101236/2021).

Figure 1.

Kale and Raut Classification of Herbal Endodontic Irrigants

Proposed classification

Herbal root canal irrigants with antimicrobial property

These extracts have demonstrated antimicrobial property against common endodontic pathogens.

For example, neem leaf extract (Azadirachta indica), Triphala, Propolis, Morinda citrifolia, Aloe vera, Garlic (Allium sativum), Ginger (Zingiber officianale), Green tea, Tea tree oil (Melaleuca alternifolia), Carvacrol, Turmeric (Curcuma longa), Arctium lappa, Babool (Acacia nilotica), Tulsi (Ocimum sanctum), Cinnamon (Cinnamomum zeylanicum), Miswak (Salvadora persica), Passion fruit juice, Jeeryin, Clove (Syzigium aromaticum), Hybanthus enneaspermus, Guava (Psidium guajava), Terminalia chebula seed extract, Mangifera indica L. kernel (Mango kernel), Zataria multiflora Essential oil, Andrographis paniculata, Thymus vulgaris, Calendula arvensis, Mimusops elengi, Syzygium cumini.[1,2,3,4,5,6,7,8,9,10]

Herbal root canal irrigants with chelating ability

These extracts possess the ability to remove the smear layer formed on the dentin surface after instrumentation.

For example, neem leaf extract (A. indica), triphala extract, M. citrifolia, garlic (A. sativum), green tea, tea tree oil (M. alternifolia), Tulsi leaf extract (O. sanctum), Miswak (S. persica), Grapefruit (Citrus paradisi), passion fruit juice, orange oil, German chamomile (Marticaria recutita), T. chebula seed extract, Amla (Emblica officinalis), Pomegranate peel (Punica granatum), Citrus aurantifolia-Sapindus mukorossi extracts, Moringa oleifera, Lemon grass, Turmeric (C. longa).[11,12,13,14,15,16]

Herbal root canal irrigants with both antimicrobial property and chelating ability

These extracts have demonstrated antimicrobial property as well as the ability to remove the smear layer.

For example, neem leaf extract (A. indica), Triphala, M. citrifolia, garlic (A. sativum), green tea, tea tree oil (M. alternifolia), Tulsi leaf extract (O. sanctum), Miswak (S. persica), passion fruit juice, T. chebula seed extract, and turmeric (C. longa).[17,18]

Herbal root canal irrigants with pulp tissue dissolution ability

These extracts possess the ability to dissolve the pulp tissue.

For example, S. mukorossi extract, Garlic (A. sativum), Nepenthes khasiana digestive fluid.[19,20,21]

OUTCOME OF CLASSIFICATION

The proposed classification delineates the diverse herbal endodontic irrigants and shall prove to be extremely beneficial for students, researchers, and clinicians.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.