Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis

Abstract

ObjectiveEnterococcus faecalis (E. faecalis) is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine (CHX) is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature.Material and MethodsA comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05.ResultsEighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles). Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa) was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (p<0.001). Random effect model demonstrated no significant difference between CH/CHX mixture and CH alone in their effect on E. faecalis (p=0.115).ConclusionsAccording to the evidence available now, mixing CH with CHX does not significantly increase the antimicrobial activity of CH against E. faecalis. It appears that mixing CH with CHX does not improve its ex vivo antibacterial property as an intracanal medicament against E. faecalis. Further in vivo studies are necessary to confirm and correlate the findings of this study with the clinical outcomes.

Endodontologie in beweging: nieuwe concepten, materialen en technieken 4. Wortelkanaaldesinfectie anno 2015

“…In onderzoek is echter een verbeterde werking van een van de componenten niet aangetoond (Saatchi et al, 2014). Chloorhexidine bindt aan negatief geladen ionen (bijvoorbeeld hydroxide-ionen).…”

Antibacterial activity of intracanal medications based on calcium hydroxide and zinc oxide micro- or nanoparticles: an ex vivo study

“…Calcium hydroxide is used as medication in teeth with pulp necrosis, promoting microorganism reduction in the RCS, favoring the endodontic treatment success 2 . Calcium hydroxide (CH) has antimicrobial effect, due to its dissociation into Ca + and OH -ions, promoting an alkaline pH 1,3 and interaction with the microorganism cell wall, and inactivating bacterial byproducts such as endotoxin [4][5][6] .…”

The Two-Component System ChtRS Contributes to Chlorhexidine Tolerance in Enterococcus faecium

“…In health care, CHX is often used in surgical scrubs for preoperative skin preparation, impregnated wash cloths for postoperative wound care, daily patient bathing, and oral care of intubated patients (16,17). Regular bathing of patients with CHX significantly reduces the colonization by VRE and other multiresistant organisms in intensive care units and general medicine wards (18)(19)(20)(21)(22)(23). Recently, increased tolerance to these compounds has been reported for Gram-positive cocci, and this could contribute to future co-or cross-selection for antibiotic resistance (24)(25)(26)(27)(28)(29)(30).…”