Efficacy of Various Intracanal Medicaments in Human Primary Teeth with Necrotic Pulp against Candida Biofilms: An in vivo Study

Abstract

BackgroundCandida has been associated with cases of secondary and persistent root canal infections. The purpose of this study was to evaluate and compare the effectiveness of commonly used intracanal medicament against Candida biofilms found in root canals of human primary teeth with necrotic pulp.Materials and methodsPulp canals of 45 single-rooted primary maxillary anterior teeth with pulp necrosis in 34 children were included in the study. They were divided into three groups of 15 samples each - group I: Ca(OH)2 (calcium hydroxide); group II: 1% chlorhexidine gel (CHX); and group III: 1% metronidazole gel. Bacterial count was obtained from each tooth at two different stages: (1) after instrumentation, and (2) after placement of the medication. Statistical analysis using the Statistical Package for the Social Sciences version 10.0 software program (Inc., Chicago, IL, USA) with Wilcoxon signed rank test after grouping the samples was performed.ResultsCa(OH)2, 1% CHX gel, and 1% metronidazole gel were ineffective in completely eliminating Candida biofilms from root canal of human primary teeth with necrotic pulp.ConclusionNone of the commonly used intracanal medicaments, i.e., Ca(OH)2, 1% CHX gel, and 1% metronidazole gel, was effective in completely eliminating Candida biofilm from root canal of human primary teeth with necrotic pulp. Ineffectiveness of these medicaments against Candida has opened new door of research regarding the use of suitable intracanal medicaments against single and multispecies biofilms.How to cite this articlePaikkatt JV, Sreedharan S, Philomina B, Kannan VP, Santhakumar M, Kumar TVA. Efficacy of Various Intracanal Medicaments in Human Primary Teeth with Necrotic Pulp against Candida Biofilms: An in vivo Study. Int J Clin Pediatr Dent 2017;10(1):45-48.

Antimicrobial activity of intracanal medications against both Enterococcus faecalis and Candida albicans biofilm

“…It has been suggested that it inhibits cell wall synthesis by leading to the coagulation of nucleoproteins, making changes in cell walls, followed by intracellular material leakage and cell death (Hiom, Furr, Russell, & Dickinson, ). In the present study, G2 was not effective against both types of biofilm, in accordance with other authors that used biofilm models (Ordinola‐Zapata et al, ; Paikkatt et al, ). Fungi are considered to be more prevalent in persistent root canal infections and reinfections that have communication with the oral cavity and in immunocompromised individuals (Egan et al, ) Studies using chlorhexidine digluconate (CHX) as a mouth rinse provided evidence that it was fungicidal against biofilm (Carvalhinho et al, ; Giuliana, Pizzo, Milici, Musotto, & Giangreco, ).…”

“…Even so, calcium hydroxide was found to be ineffective in eliminating E. faecalis, which is linked to cases of endodontic treatment failure due to their resistance to alkaline media, particularly when it is found in the form of biofilm (Zancan et al 2016). C. albicans biofilm was also resistant to this paste (Paikkatt et al, 2017), that may explain its isolation in pure culture in cases of persistent apical periodontitis. (Waltimo, Siren, Orstavik, & Haapasalo, 1999; Table 1).…”

Antimicrobial activity of Psidium cattleianum associated with calcium hydroxide against Enterococcus faecalis and Candida albicans: an in vitro study

“…Candida albicans is the most common yeast isolated from the oral cavity or root canals and has the ability to form bilayer biofilm, rich in an extracellular matrix composed by carbohydrates, proteins, phosphorus, and hexosamines, allowing good tolerance and growth in nutrient-restricted environments, as occurs in retreatment of the canal system [13,14]. Also, has been considered tolerant to chemical compounds commonly used in the biomechanical instrumentation of infected root canals or dressings, such as calcium hydroxide [15][16][17], and this resistance may be comparable to that evidenced for E. faecalis [18]; E.faecalis is a cocci Gram-positive anaerobe facultative which occur in primary root canal infections and is the most common organism cultured from failed root canal therapy, with 12-90% prevalence [19]. Both species exhibit similar starvation survival behaviors and are capable of starvation survival for 6 months, using low levels of serum for growth.…”

Selected Properties of Contemporary Endodontic Sealers: Part 1

“…Ďalším mikroorganizmom spojeným s infekciami odolnými voči endodontickej liečbe je Candida albicans, ktorá je taktiež odolná voči pôsobeniu hydroxidu vápenatého, najmä ak je prítomná v podobe biofilmu [40]. Taktiež je vplyvom rastu v alkalických podmienkach schopná silnejšie adherovať ku kolagénu, čo zvyšuje jej infekčnosť a tiež zvyšuje pravdepodobnosť vzniku reziduálnej infekcie [41,42]. Vápnik v hydroxide vápenatom podporuje adherenciu Candidy ku kolagénu, vysoké pH zas podporuje Candidu k tvorbe hýf, ktoré penetrujú hlboko do dentínových tubulov, čím zvyšujú infekčnosť tohto mikroorganizmu [41,43].…”