Assessment of Nitrofurantoin as an Experimental Intracanal Medicament in Endodontics

Abstract

Background and Objectives. Multiple antibacterial agents have been mixed and used as an intracanal medicament-like modified triple antibiotic paste (MTAP) to eliminate Enterococcus faecalis (EF), which has been most frequently identified in the cases of failed root canal treatment and periapical lesions. This study is aimed at using a single antibacterial agent, nitrofurantoin (Nit), as an experimental intracanal medicament paste against different clinical isolates of EF bacteria and at comparing its antimicrobial efficacy with MTAP. Materials and Methods. Three strains of EF (S1, S2, and S3) were clinically isolated. A total of 198 straight single-rooted human teeth were collected and divided randomly into three main groups: group N (Nit) (n=90), group M (MTAP) (n=90), and group W (distilled water) (n=18). The main groups were subdivided into three subgroups according to the strain of EF: in groups N and M, subgroups S1, S2, and S3 (n=30), while in group W, subgroups S1, S2, and S3 (n=6). Then, each subgroup of N and M was divided into five groups (n=6) according to the concentrations of Nit or MTAP (6.25, 12.5, 25, 50, and 100 mg/mL). The colony-forming unit (CFU) of EF from the canal lumen and dentinal chips was measured. Results. Nit could eradicate S1, S2, and S3 completely with concentrations of 6.25, 12.5, and 25 mg/mL, respectively, while MTAP showed complete eradication of the three strains only at 25 mg/mL. In all the groups, it was found that the CFU counts of EF in the dentinal chips were higher than those in the root canal lumen. Conclusion. At the concentration of 25 mg/mL, the Nit paste is effective in eradicating EF completely when it is used as an intracanal medicament.

Comparison of Single Antibiotic Paste Nitrofurantoin and Calcium Hydroxide Paste as Intracanal Medicaments in Alleviating Post-Operative Pain in Patients with Symptomatic Irreversible Pulpitis -A Randomized Controlled Trial

“…In this study, patients assigned to Group 1 were allotted Nitrofurantoin as the intracanal medicament in their root canal treatments, Group . Nitrofurantoin in the powdered form was mixed and then normal saline was mixed in this powder (liquid: powder 1ml:100mg) to prepare 100mg/ml Nitrofurantoin paste [6]. The paste formed was carried in the root canals of the patients using Lentilospiral.…”

“…Considering the flora of anaerobic bacteria predominant in the root canals of patients suffering from irreversible pulpitis, this drug has been shown to be effective in its antimicrobial action, especially against Enterococcus faecalis as well as pain-relieving capabilities according to a recent study in literature [6]. A study reports Enterococcus faecalis to be 80.32% susceptible to Nitrofurantoin [26].…”

“…Trans-dentinal and antimicrobial effects of nitrofurantoin have been evaluated with positive outcomes in eradicating Enterococcus faecalis but limited trans-dentinal diffusion of the medicament [5]. Nitrofurantoin has been used experimentally as an intracanal medicament with positive results in the elimination of Enterococcus faecalis [6].…”

“…Visual Analogue Pain Scale 0= No pain, 1-3= Mild Pain, 4-6= Moderate Pain, 7-10=Severe Pain 2 was allotted Calcium Hydroxide Paste (Meta BioMed -Metapex-Calcium Hydroxide with Iodoform), and Group 3 was Control (No intracanal medicament). Nitrofurantoin in the powdered form was mixed and then normal saline was mixed in this powder (liquid: powder 1ml:100mg) to prepare 100mg/ml Nitrofurantoin paste[6]. The paste formed was carried in the root canals of the patients using Lentilospiral.…”

Antimicrobial efficacy of a new tri-antibiotic combination against resistant endodontic pathogens: An in-vitro study

“…Intracanal application of multi-antimicrobial preparations reduces the chances of systemic toxicity and achieves almost complete microbial elimination at very low concentrations [14]. The topical multi-antimicrobial preparations have been used against endopathogens with variable success [15,16].…”