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Int Poster J Dent Oral Med 14 (2012), No. 4     15. Dec. 2012

Int Poster J Dent Oral Med 2012, Vol 14 No 4, Poster 621

Antifungal Efficacy of 5·25 percent sodium hypochlorite , 2 percent chlorhexidine gluconate and 17 percent EDTA with and without antifungal agent as root canal irrigant

Language: English
 

Authors:
Prof. Dr. K. K. Wadhwani, Dr. Richa Gupta, Junior Resident, Dr. Mukesh Hasija, Senior Resident,
King George Medical University, Faculty of Dental Sciences, Department of Conservative Dentistry and Endodontics, Lucknow, Uttar Pradesh, India

Date/Event/Venue:
Twelfth November 2011
Twentysixth Federation of Operative Dentistry of India and nineteenth Indian Endodontic Society National Conference
Manekshaw Convention Centre, New Delhi, India

Poster Award
First Prize

Introduction

Numerous studies have revealed possible role of fungus in the incidence of endodontic infections. After Enterococcus faecalis Candida albicans is one of the most relevant microorganism associated with failed endodontic treatment. Resistance to calcium hydroxide and its ability to penetrate into dentinal tubules are possible reasons for the occurence of oral candida species in cases of post treatment apical periodontitis.
 

Objectives

The aim of this invitro study was to evaluate the antifungal efficacy of 5·25 percent Sodium Hypochlorite, 2 percent Chlorhexidine Gluconate, and 17 percent EDTA as final irrigant with and without the inclusion of an Antifungal agent that is 1 percent Clotrimazole on Candida albicans.
 

Material and Methods

Thirty single rooted teeth were selected. They were decoronated and chemomechanically prepared with the help of Gated Glidden drills and Kerr files. Then they were inoculated with candida albicans suspension. After this they were incubated at 37° celsius and 91 percent humidity for 96 hours.These 30 samples were divided into TWO groups of 15 samples each.

GROUP 1 - Without antifungal agent
GROUP 2 - With antifungal agent that is 1 percent Clotrimazole.

The GROUP 1 containing 15 samples was further subdivided into three subgroups of 5 samples each. Samples in subgroup 1 were irrigated with 5·25 percent sodium hypochlorite, samples in subgroup 2 were irrigated with 2 percent chlorhexidine gluconate, and samples in subgroup 3 with 17 percent EDTA.

The GROUP 2 containing 15 samples which is with antifungal agent was similarly subdivided into three subgroups of 5 samples each and was similarly irrigated with 5·25 percent sodium hypochlorite, 2 percent chlorhexidine gluconate, and 17 percent EDTA respectively but was followed by 1percent clotrimazole as a final rinse. Then aliquots from these samples were plated on 4 percent sabouraud agar, and the colony forming units were evaluated.

Fig. 1: 30 single rooted teeth were selected Fig. 2: While decoronating
Fig. 3: After decoronation Fig. 4: While biomechanical canal preparation using gates glidden drills
Fig. 5: Doing biomechanical canal preparation using kerr files Fig. 6: Canals prepared
Fig. 7: Teeth samples ready for inoculation Fig. 8: Candida suspension
Fig. 9: While inoculation Fig. 10: While placing in incubator
Fig. 11: Group 1 containing 15 samples Fig. 12: Group 2 containing 15 samples
 

Results

5·25 percent sodiumhypochlorite exhibited superior antifungal efficacy compared to 2 percent chlorhexidine gluconate and 17 percent EDTA. On inclusion of 1 percent clotrimazole, there was a significant decrease in colony forming units. 5·25 percent sodiumhypochlorite and 2 percent chlorhexidine gluconate with clotrimazole showed significantly greater antifungal properties than 17 percent EDTA with clotrimazole.

Fig. 13: Sub group 1 irrigated with sodium hypochlorite Fig. 14: Subgroup 2 irrigated with chlorhexidine gluconate
Fig. 15: Subgroup 3 irrigated with ethylene diamine tetraacetic acid Fig. 16: Plates before inoculation
Fig. 17: While plating samples Fig. 18: After plating of samples
Groups Mean (CFU)
Group 1 (without antifungal agent)
5.25% NaOCl 22.20
2% CHX 34.40
17% EDTA 62.60
Group 2 (with antifungal agent)
5.25% NaOCl + Clotrimazole 8.40
2% CHX + Clotrimazole 12.60
17% EDTA + Clotrimazole 28.20
Control group
Distilled water 124.20
Tab. 1: Results showing mean colony forming units of candida in each group NaOCl stands for sodium hypochlorite EDTA stands for ethylene diamine tetraacetic acid CHX stands for chlorhexidine gluconate CFU stands for colony forming units
Fig. 19: Plates showing growth of candida in control samples Fig. 20: Plates showing growth of candida in samples irrigated with sodium hypochlorite
Fig. 21: Plates showing growth of candida in samples irrigated with sodium hypochlorite followed by clotrimazole as final rinse Fig. 22: Plates showing growth of candida in samples irrigated with chlorhexidine gluconate
Fig. 23: Plates showing growth of candida in samples irrigated with chlorhexidine gluconate followed by clotrimazole as final rinse Fig. 24: Plates showing growth of candida in samples irrigated with ethylene diamine tetraacetic acid
Fig. 25: Plates showing growth of candida in samples irrigated with ethylene diamine tetraacetic acid followed by clotrimazole as final rinse Fig. 26: Graph depicting colonies of candida in each group in the units of 1000 colony forming units per milliliter NaOCl stands for sodium hypochlorite EDTA stands for ethylene diamine tetraacetic acid CHX stands for chlorhexidine gluconate
 

Conclusions

Clotrimazole, a substituted imidazole, is a commonly used antifungal in both medical and dental practice. It is one of a family of azoles ans is useful in treating systemic mycoses. A poorly functioning immune system might increase the risk of fungal infection in root canal system. Therefore, disinfection of root canal system during cleaning and shaping procedures should incorporate an antifungal agent to target fungi specifically in immunocompromised patients like for example diabetics.
 

Literature

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Abbreviations

EDTA: Ethylene Diamine Tetraacetic Acid
NaOCl: Sodium hypochlorite
CHX: Chlorhexidine gluconate
 

This Poster was submitted by Prof. Dr. Mrs. K. K. Wadhwani.
 

Correspondence address:
Prof. Dr. Mrs. K. K. Wadhwani
King George Medical University
Faculty Of Dental Sciences, Department of Conservative Dentistry and Endodontics
Lucknow, Uttar Pradesh
India 226003