Search

Sodium hypochlorite (NaOCl) is widely utilized in endodontics for its effective antimicrobial properties and ability to dissolve necrotic tissues. However, its use is not devoid of risks, including potential severe tissue damage and chemical burns. This systematic review evaluates the documented risks of using NaOCl in endodontic treatments. It compares its safety and efficacy with other endodontic irrigants, such as EDTA and chlorhexidine. This review followed the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines and registered with PROSPERO. Comprehensive searches were performed in PubMed, Scopus, Web of Science, and CENTRAL databases, with additional hand searches in grey literature. Studies were selected reporting adverse effects related to NaOCl used in endodontic procedures, ranging from randomized controlled trials to case reports. Data extraction and risk of bias assessment were systematically performed using standardized tools. Seventeen studies were included, detailing instances from chemical burns to severe allergic reactions and tissue necrosis associated with NaOCl use. The risk of bias was predominantly low across the studies. Sodium hypochlorite demonstrated a higher efficacy in microbial eradication and tissue dissolution than other irrigants, though it also showed a higher incidence of severe complications when mishandled. Sodium hypochlorite remains a cornerstone in endodontic disinfection due to its potent antimicrobial and tissue dissolution properties. However, its application must be meticulously managed to prevent complications. Future research should focus on optimizing concentrations and application techniques to enhance safety and effectiveness, potentially integrating safer alternatives or complementary solutions like EDTA to mitigate risks while preserving irrigant benefits., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Endodontic irrigation protocols are not only used to clean and disinfect the root canal system, but also to condition the canal wall dentine for subsequent root filling. In this study we tested whether a final irrigation step with saline solution or 80% ethanol improved root canal sealabilty by two popular sealers, an epoxy resin (AH Plus) and a hydraulic calcium silicate cement-based product (BioRoot RCS). Root canals in extracted single-rooted human teeth were instrumented and filled with a matched gutta-percha cone and sealer. During instrumentation and prior to root filling, sealer-specific irrigation protocols were applied. These involved a combined sodium hypochlorite/1-hydroxyethylidene-1,1-diphosphonic acid application, which was followed by irrigation with ethylenediaminetetraacetic acid (EDTA) for AH Plus. Protocols were followed by a 5-ml ultimate rinse with saline solution or 80% ethanol. No such final rinse was the control (N = 9). Canals were then dried with matched paper points. One week after root filling and storage of the teeth at 37°C in a humid environment, Rhodamine B was used to trace leakage. Two-way ANOVA revealed that the type of sealer had a significant (P < 0.05) impact on apical dye penetration while the final rinse did not (P > 0.05). AH Plus provided the slightly better seal (P < 0.05). Leakage occurred between the sealer and the dentin with AH Plus, and between the sealer-to-dentin as well as the sealer-to-gutta-percha interface with BioRoot RCS. In summary and under current conditions, there was no benefit from applying saline or ethanol as an ultimate rinsing solution prior to drying the canal with matched paper points., (Copyright 2024 Nidambur Vasudev Ballal, Rajkumar Narkedamalli, Josette Camilleri, Vasileios Kapralos, Matthias Zehnder. License: This work is licensed under a Creative Commons Attribution 4.0 International License.)

Introduction: This study systematically reviewed literature regarding the effect of different concentrations of sodium hypochlorite (NaOCl) used during root canal treatment (RCT) on postendodontic pain (PEP) and rescue analgesia., Methods: Following registration with PROSPERO (CRD42023388916), a search was conducted using PubMed, Scopus, Web of Science, and Embase databases. Randomized controlled trials of patients receiving RCT which assessed PEP at different time intervals were included. Following data extraction and Cochrane risk of bias assessment 2, meta-analyses were performed to evaluate PEP during the first 48 hours along with rescue analgesic intake. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach., Results: Five randomized controlled trials with 674 patients were included. One study exhibited a low risk of bias, while 4 raised some concerns. Patients treated with low concentrations of NaOCl (≤3%) were significantly less likely to report PEP at 24 hours (OR = 2.32; [95% CI, 1.63-3.31]; P < .05) and 48 hours (OR = 2.49; [95% CI, 1.73-3.59]; P < .05) as compared with high concentrations of NaOCl (≥5%). Furthermore, with low concentrations of NaOCl, significantly lesser moderate-severe PEP was reported at 24 hours (OR = 2.32; [95% CI, 1.47-3.62]; P < .05) and 48 hours (OR = 2.35; [95% CI, 1.32-4.16]; P < .05) and lesser analgesia was needed (OR = 2.43; [95% CI, 1.48-4.00]; P < .05)., Conclusions: While PEP can be influenced by several factors, low certainty evidence suggests that when NaOCl is used as an irrigant during RCT, PEP may be less likely with lower concentrations of NaOCl. Moderate certainty evidence indicates that lesser analgesia may be required with lower concentrations of NaOCl. These results should be cautiously interpreted., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Aim: To evaluate the 6-year outcome of root canal treatment irrigated with 0.5% or 3% sodium hypochlorite (NaOCl)., Methodology: The baseline trial was designed as a quasi-randomized clinical trial. Patients referred for root canal treatment to an endodontic specialist clinic were recruited to the study (n = 298). The concentration of NaOCl was allocated quasi-randomized to 271 subjects (0.5% [n = 139], 3% [n = 132]). Bacterial sampling was performed immediately before root canal filling. Samples were cultured and evaluated as growth or no growth. Patients were invited to a clinical and radiological follow-up >5 years postoperatively. The clinical outcome measurements were tooth survival, cumulative incidence of endodontic retreatments, patients' assessment of pain, clinical findings and radiological signs of apical periodontitis (AP)., Results: Tooth survival was 85.6% in the 0.5% NaOCl group and 81.1% in the 3% NaOCl group (p = .45). There was no record of retreatment in 94.4% in the 0.5% NaOCl group and in 92.2% in the 3% NaOCl group (p = .76). The percentage of asymptomatic cases were 87.8% in the 0.5% group and 85.3% in the 3% NaOCl group (p = .81). Absence of clinical signs of AP was seen in 86.6% in the 0.5% NaOCl group and in 83.6% in the 3% NaOCl group (p = .80). Absence of radiological signs of AP was seen in 74.0% in the 0.5% NaOCl group and 64.1% in the 3% NaOCl group (p = .20). Subjects with positive culture before root filling reported subjective pain with a significantly higher frequency as compared to negative-culture subjects (p = .014)., Conclusions: The use of 0.5% or 3% NaOCl for irrigation during root canal treatment resulted in similar clinical outcomes 5-7 years postoperatively. Persisting bacteria immediately before root filling may predict future episodes of subjective pain., (© 2024 The Author(s). International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)

Objective: To evaluate the effect of different agitation methods on apical extrusion of 1.5% sodium hypochlorite (NaOCl) in an ex vivo model of immature teeth., Methods: Sixty extracted human inferior incisors were prepared to simulate immature teeth and embedded in an artificial root socket made of silicone impression material. The teeth were then divided into four groups: Conventional needle irrigation (CNI) alone, CNI supplemented with Ultrasonic Irrigant Activation (UIA), EasyClean (EC), or XP-endo Finisher (XPF). Extruded NaOCl was collected, reacted with m-cresol purple, and its absorbance values were measured. The data were statistically analyzed using One-way analysis of variance with a significance level of 5%., Results: All groups showed apically extruded irrigating solution, and the mean volumes of extruded NaOCl did not differ significantly between any of the test groups (p⟩0.05)., Conclusion: The activation of 1.5% NaOCL by UIA, EC, or XPF as supplementary to CNI does not promote greater apical extrusion when compared to CNI alone in simulated immature teeth., (Copyright© 2024 Dennis Barber Ltd.)

Abstract: This case report reviews the effect of combining a 250-cc bottle of standard antimicrobial, buffered sodium hypochlorite with a surgical method, low-pressure jet lavage irrigation in the outpatient setting to control difficult wound contamination. A 73-year-old man had been in treatment for over 8 years, undergoing at least 18 surgical wound debridement procedures for an extensive undermined pelvic pressure injury involving the sacrum, ischium, and greater trochanter. Cultures and polymerase chain reaction diagnostics revealed a multibacterial presence. Autofluorescent imaging (AFI) was used in 21 examinations performed after a 72-hour delay over a long weekend. The AFI contamination exceeded log 4 colony-forming units/g of tissue in all pretreatment examinations and was reduced to less than log 2 colony-forming units in 6 of 21 examinations, with the remaining 15 showing an estimated 80% or higher removal of the bacterial porphyrin "red" appearance. A total of 54 AFI examinations were performed using the combination treatment, and no adverse reactions were encountered. Treatment paradigms can be improved with a multifactorial approach., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

The aim of this study was to evaluate the efficacy of continuous apical negative ultrasonic irrigation into simulated lateral canals and the apical third in straight and curved root canals. Two simulated lateral canals were created 2, 4 and 6 mm from the working length in 120 single-rooted teeth (6 canals/tooth, n = 360 straight, n = 360 curved). The teeth were randomly divided into 3 experimental groups: positive pressure irrigation (PPI) (n = 20); passive ultrasonic irrigation (PUI) (n = 20); continuous apical negative ultrasonic irrigation (CANUI) (n = 20). 20% Chinese ink was added to a 5% sodium hypochlorite solution and delivered into the root canals. The results showed a significantly higher (P < 0.05) penetration of irrigant into the lateral canals and up to working length in the CANUI group for straight and curved roots. CANUI improves penetration into the lateral canals and up to the working length of the cleared teeth in straight and curved roots.

Introduction: Calls to poison control about exposure to household cleaners have increased during the COVID-19 pandemic. This dynamic may reflect increased exposure from public health efforts as well as health misinformation shared on social media., Methods: We analyzed the dynamics of calls to the Regional Center for Poison Control and Prevention serving Massachusetts and Rhode Island (MARI PCC) and tweets discussing treating COVID-19 with house cleaners from January 20, 2020 to May 5, 2020. We obtained publicly available tweets discussing the use of household cleaners to "cure COVID" from the same time period with geographic co-ordinates indicating that they were emitted from the Greater Boston Area., Results: Our main finding is that public health efforts were followed by a sustained increase in calls after March 15, 2020 (10 ± 2 calls per day before to 15 ± 2.5 after) while misinformation on social media was associated with intermittent spikes in calls. Overall, calls significantly increased during the study period by 34% as compared to the previous 8 years, mostly reporting unintentional ingestions with no serious effects. The daily volume of tweets and retweets was significantly correlated with daily call rates to MARI PCC for the surrounding 7-10 days., Conclusions: Health misinformation on social media about using household cleaning agents to treat COVID-19 and public health efforts lead to different dynamics in PCC calls. Public health efforts were followed by a sustained increase in calls after March 15, 2020 while misinformation on social media was followed by intermittent spikes in calls. This analysis is the first to link the geospatial dynamics of social media and public health interventions to poison center calls about exposure to household cleaners.

Decontamination of pathogens on surfaces of substances is very important for controlling infectious diseases. In the present experiments, we tested various disinfectants in aqueous phase as well as on plastic surface carrying a viral inoculum, through dropping and wiping decontamination techniques, comparatively, so as to evaluate virucidal efficacies of those disinfectants toward an avian coronavirus (infectious bronchitis virus: IBV). We regard this evaluation system applicable to SARS-CoV-2. The disinfectants evaluated were 0.17% food additive glade calcium hydroxide (FdCa(OH) 2 ) solution, sodium hypochlorite at 500 or 1,000 ppm of total chlorine (NaClO-500 or NaClO-1,000, respectively), NaClO at 500 ppm of total chlorine in 0.17% FdCa(OH) 2 (Mix-500) and quaternary ammonium compound (QAC) diluted 500-fold in water (QAC-500). In the suspension test, all solutions inactivated IBV inoculum that contained 5% fetal bovine serum (FBS) under detectable level within 30 sec. In the carrier test, all solutions, except NaClO-500, could inactivate IBV with 0.5% FBS on a carrier to undetectable level in the wiping-sheets and wiped-carriers. We thus conclude that suspension and carrier tests should be introduced to evaluate disinfectants for the field usage, and that this evaluation system is important and workable for resultful selection of the tested disinfectants against avian coronavirus and SARS-CoV-2 on surfaces, particularly on plastic fomite.

The combination of ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) has been advocated as an effective irrigation methodology to remove organic and inorganic matter in root canal therapy. Yet, it was suggested that both solutions might lead to structural changes of the dentinal wall surface, depending on the order of application which might affect sealer mechanical retention. This study aims to evaluate the effect of different irrigating protocols on dentin surface roughness using quantitative 3D surface texture analysis. Data stems from 150 human root dentin sections, divided into five groups, each prepared according to one of the following protocols: Negative control; 17% EDTA; 17% EDTA followed by 5.25% NaOCl; 5.25% NaOCl; and 5.25% NaOCl followed by 17% EDTA. Each dentin sample was examined for its three-dimensional surface texture using a high-resolution confocal disc-scanning measuring system. EDTA 17% and the combined EDTA 17% with NaOCl 5.25% showed considerably higher roughness properties compared to the control and to NaOCl 5.25% alone. However, the irrigation sequence did not affect the dentin roughness properties. Therefore, mechanical retention is probably not dependent upon the selection of irrigation protocol sequence.

Coronaviruses present a considerable concern for humans and animals. The current world- wide pandemic of SARS-CoV-2 virus showed many gaps in understanding of coronaviruses spread and transmission. Because of lack of effective vaccine against SARS-CoV-2 the only preventive measures are represented by wearing protective masks and gloves thus limiting potential risk of contact with the airborne virus. Inversely, the limited time of protective function of the masks presents another drawback of their use. Therefore, the application of disinfection agent dispersed on the surface of protective masks may enhance their effectivity and safety of their application. The aim of the study was to examine the virucidal efficacy of low-concentra- ted sodium hypochlorite dispersed using ultrasonic humidifier on the surface of surgery masks. The study was conducted using SARS-CoV-2 surrogate virus, namely porcine epidemic diarrhea virus (PEDV) representing a model with similar biophysical properties and genomic structure to human coronaviruses. Five different concentrations of the disinfectant with different content of sodium hypochlorite were selected for the study. A final concentration of 0.228 g/L sodium hypochlorite effectively inactivated the PED virus and may support the biosafety of masks usage., (Copyright© by the Polish Academy of Sciences.)

Background: Decontaminating and reusing filtering facepiece respirators (FFRs) for healthcare workers is a potential solution to address inadequate FFR supply during a global pandemic., Aim: The objective of this review was to synthesize existing data on the effectiveness and safety of using chemical disinfectants to decontaminate N95 FFRs., Methods: A systematic review was conducted on disinfectants to decontaminate N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted predefined data fields. Original research reporting on N95 FFR function, decontamination, safety, or FFR fit following decontamination with a disinfectant was included., Findings and Conclusion: A single cycle of vaporized hydrogen peroxide (H 2 O 2 ) successfully removes viral pathogens without affecting airflow resistance or fit, and maintains an initial filter penetration of <5%, with little change in FFR appearance. Residual hydrogen peroxide levels following decontamination were within safe limits. More than one decontamination cycle of vaporized H 2 O 2 may be possible but further information is required on how multiple cycles would affect FFR fit in a real-world setting before the upper limit can be established. Although immersion in liquid H 2 O 2 does not appear to adversely affect FFR function, there is no available data on its ability to remove infectious pathogens from FFRs or its impact on FFR fit. Sodium hypochlorite, ethanol, isopropyl alcohol, and ethylene oxide are not recommended due to safety concerns or negative effects on FFR function., (Copyright © 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Saturated salt floatation method is widely used for coccidian oocyst purification. However, the repeated procedures and inefficient oocysts recovery rate are a continuous challenge. This study aimed to investigate the best suitable floatation solution, along with optimal centrifugation speed and time for Eimeria tenella (E. tenella) oocyst and sporocyst purification. Different floatation solutions i-e, saturated salt, Sheather's sugar and sodium hypochlorite (NaClO) at 20-60% concentrations were used to purify oocyst. It was found that about 96.99% oocysts (8609×g for 10 min) were recovered under these conditions without any effect on the viability of sporocysts. The recovery rate of oocysts using 50% NaClO (V/V) was significantly higher than 35% saturated salt flotation solution (P < 0.05). The optimal method for purification of oocysts based our experimentation was centrifugation at 8609×g for 3 min using 50% NaClO floatation solution, and the optimized centrifugation conditions for improved recovery of sporocysts (about 99.3%) were at 2152×g for 5 min. The present study provided a better method for the coccidian oocyst purification, which could be successfully adopted as a better alternative to existing techniques commonly used for investigations/research pertaining to coccidia., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: The objective of this study is to evaluate the wall adaptation and apical microleakage values following the application of various irrigation protocols in primary teeth. Material and methods: For the two parts of the study, extracted upper incisor primary teeth were randomly included to the 1% sodium hypochlorite (NaOCl), 10% ethylenediaminetetraacetic acid (EDTA)+1% NaOCl, 6% citric acid (CA)+1% NaOCl and 0.9% physiological saline (PS) groups. Canal wall adaptation and apical microleakage were assessed by scanning electron microscopy (SEM) and stereomicroscope, respectively. Results: 6% CA + 1% NaOCl group was found to be the most successful irrigation protocol in providing strong canal wall adaptation and less apical microleakage, followed by 10% EDTA +1% NaOCl. 6% CA +1% NaOCl was significantly superior regarding apical microleakage ( p  < .05). Conclusions: Due to the ability to provide appropriate changes in the root canal walls to make a well-adapted and leak-proof canal filling, 6% CA + 1% NaOCl can be recommended as an irrigation protocol in primary teeth.

The gutta-percha cones used in endodontic treatment are produced in aseptic conditions and their composition includes zinc oxide, which is responsible for antibacterial activity. However, there is the possibility of microbial contamination by manipulation, aerosol or during storage. Although several chemical agents have been tested for their decontamination, there is no consensus on the best disinfection protocol to be used. The aim of this study was to evaluate the decontamination of gutta-percha cones contaminated with the bacteria Enterococcus faecalis, by using chlorhexidine digluconate (CHX) and sodium hypochlorite (NaClO) at different concentrations for short exposure times. For this purpose, gutta-percha cones (size 40) were selected at random from a sealed box and immersed for 1 min in a microbial suspension. Then they were immersed in specific Petri dishes for different groups containing: CHX 2%, NaClO 1% or NaClO 2.5% for 30 s or 1 min, and subsequently placed in tubes containing BHI broth. After incubating the tubes for 48 h, it was observed that 1% and 2.5% NaClO and 2% CHX were effective for decontaminating the cones at those exposure time intervals. Microbial growth was detected in one of the replicates of the group with CHX applied for 30 s. To prevent the possibility of failures at this stage, the exposure time of gutta-percha cones to the decontaminating agent should not be reduced.

Chlorine-based disinfectants are commonly used in rooms of patients with Candida auris, but there is uncertainty regarding optimal concentrations that provide efficacy while minimizing the potential for adverse effects. We found that 2 chlorine-based disinfectants were effective against C auris with 1 minute of contact time at concentrations of 4,000 parts per million or higher. Lower concentrations were effective only with increased contact times that may not be practical in real-world health care settings., (Published by Elsevier Inc.)

Erysipelothrix piscisicarius is an emergent pathogen in fish aquaculture, particularly in the ornamental fish trade. Very little is known on the biology of this pathogen; however, the recurrence of infection and disease outbreaks after removing the fish from a system and disinfecting the tank suggest its environmental persistence. Moreover, biofilm lifestyle in E. piscisicarius has been suspected but not previously shown. The purpose of this study was to investigate the formation of biofilms on an abiotic surface in Erysipelothrix spp. We used hydroxyapatite-coated plastic pegs to demonstrate the attachment, growth, and persistence of E. piscisicarius on abiotic surfaces in both fresh and marine environments and to investigate the susceptibility of this pathogen to different disinfectants that are used in the aquaculture industry. E. piscisicarius formed biofilms that persisted significantly longer than planktonic cells did in both freshwater and saltwater over a period of 120 h (P = 0.004). The biofilms were also more resistant to disinfectants than the planktonic cells were. Hydrogen peroxide was the most effective disinfectant against E. piscisicarius, and it eradicated the biofilms and planktonic cells at the recommended concentrations. In contrast, Virkon and bleach were able to eradicate only the planktonic cells. This information should be taken into consideration when developing biosecurity protocols in aquaculture systems, aquariums, and private collections., (© 2020 American Fisheries Society.)

Background and Objectives: Intracanal disinfection plays an important role in endodontic treatment success. Enterococcus faecalis (E. faecalis) is a resistant microorganism responsible for endodontic infections. We aimed to assess the bactericidal effects of three disinfection methods on E. faecalis biofilm., Materials and Methods: Fifty-five freshly extracted single-rooted human teeth were evaluated. A barbed broach was used to extract the pulp tissue. No further root canal preparation was performed. Specimens were sterilized with gamma radiation, and inoculated with E. faecalis suspension. They were then incubated for 4 days and 4 weeks. Biofilm formation was confirmed using a scanning electron microscope (SEM). The teeth were randomly assigned to three subgroups (n = 7) to assess the antimicrobial efficacy of the following three disinfection methods against immature (4-day) and mature (4-week) biofilms: the conventional chemomechanical debridement (CCMD), CCMD + light-activated disinfection (LAD; 810 nm, 0.3 W, 120 J/cm 2 ) with indocyanine Green (EmunDo) as photosensitizer and CCMD + diode laser irradiation (810 nm, 2 W). The teeth were then longitudinally split into two halves and the colony count was reported as colony forming units (CFUs) to assess bacterial viability after each disinfection protocol., Results: None of the disinfection methods could completely remove the biofilm. CCMD + LAD caused the highest and CCMD + diode laser caused the lowest reduction in biofilm. Antibacterial efficacy was significantly lower against the mature (4-week) biofilm compared with immature (4-day) biofilm in all groups (P < 0.05)., Conclusion: All three disinfection methods were effective for partial elimination of E. faecalis biofilm. But CCMD + LAD was significantly more efficacious in decreasing both mature and immature biofilms., Competing Interests: Declaration of Competing Interest None., (Copyright © 2019. Published by Elsevier B.V.)

Objective: To compare the antibacterial effectiveness of 0.5% sodium hypochlorite (NaOCl) activated by the Er,Cr:YSGG laser-activated irrigation (LAI) and passive ultrasonic irrigation (PUI) against a 10-day-old intracanal Enterococcus faecalis biofilm. Background: LAI and PUI are regarded as alternative methods to release the irrigant in the inner regions of the root canal system achieving enhanced cleaning ability. Nevertheless, little evidence regarding the activation of low concentrations of NaOCl has been reported. Materials and methods: Seventy-two single-rooted teeth were instrumented, inoculated ( E. faecalis ATCC 29212), and incubated for 10 days to allow biofilm formation. Specimens were randomly divided into six groups ( n  = 12 each): (1) 0.5% NaOCl+Er,Cr:YSGG LAI, (2) saline+Er,Cr:YSGG LAI, (3) 0.5% NaOCl+PUI, (4) saline+PUI, (5) positive control (no treatment), and (6) negative control (no bacteria). The activation time was distributed as follows: 30 sec of activation, followed by a rest phase of 30 sec, and ending with 30 sec of activation. The number of bacterial survivors was determined by plate counting. Results: Both irrigation regimens LAI and PUI reduced the number of colony-forming unit. Moreover, LAI +0.5% NaOCl and the rest of groups significantly differ ( p  < 0.001 for all comparisons). Conclusions: Er,Cr:YSGG LAI proved to be more effective than PUI in enhancing the antimicrobial activity of 0.5% NaOCl against 10-day-old intracanal E. faecalis biofilms.

Environmental disinfection with sodium hypochlorite and hydrogen peroxide vapor was performed after a hospital-associated outbreak of Middle East respiratory syndrome. Although only 11% of total beds were disinfected, the isolation and vancomycin-resistance rates of Enterococcus spp significantly decreased for 2 months, whereas other multidrug-resistant organisms did not., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of the present vitro study was to examine the question whether devitalized Enterococcus faecalis (E. faecalis) cells can migrate into dentinal tubules and if that process takes place in a time-dependent manner., Design: Sixty bovine root canals were incubated with devitalized and vital streptomycin-resistant E. faecalis strains after root canal enlargement (size 80, taper .02) with 3% NaOCl solution. Incubation times 7, 14, 21, 28, 35, and 42 days. Samples were processed for analysis by scanning electron microscopy (SEM) and DAPI (4',6-diamidino-2-phenylindole) staining. The penetration depth was calculated with the measurement tool of the Axio Vision program (Zeiss, Jena, Germany). Statistical analysis was performed by Kruskal-Wallis (α = 0.05) and Mann-Whitney U test (p < 0.05)., Results: Devitalized E. faecalis strains were able to migrate into dentinal tubules. The total number and penetration depth of devitalized E. faecalis cells was lower compared to the vital suspension of E. faecalis. It was noted, that bacterial penetration was not common to all of the dentinal tubules in the vital E. faecalis control and especially in the devitalized control. The migration took place in a time-dependent migration characteristic., Conclusions: Devitalized E. faecalis cells are still able to migrate into the dentinal tubules due to possible electrokinetic and osmotic processes. Thereby, increased exposure times lead to a time-dependent penetration characteristic., Clinical Relevance: Since devitalized bacteria can migrate as well into dentinal tubules, the presence of bacteria within dentinal tubules cannot be interpreted as a failure of tested preparation regimens.

Background: Endodontic treatment is one of the most widely performed procedures in a dental office. New techniques for enhancing the effectiveness of irrigants are being introduced into the dental market. It is crucial to choose a proper method to obtain the highest possible long-term success of performed endodontic treatment. Sodium hypochlorite (NaOCl) appears to be one of the most common and profitable solutions for root canal irrigation. The activation of a solution may be analyzed in 2 fields, physical - turbulence of flow, and chemical - disintegration of irrigant molecules into very active radicals that improve its activity. While the physical alternations of irrigant flow with different techniques are widely studied, there are not many attempts to approach the subject in chemical terms., Objectives: The aim of the study was to compare the chemical effectiveness of 2 methods of NaOCl activation: ultrasonics vs the Self-Adjusting File system (SAF) as an adjunct to increase the efficacy of the irrigant., Material and Methods: The level of activation was evaluated via a reaction of the activated NaOCl samples, with 9-fluorenol as the starting organic material. The model reaction is based on the oxidation of 9-fluorenol to 9-fluorenon. The evaluation was performed using 1H nuclear magnetic resonance (NMR) spectroscopy, comparing the spectra obtained for the examined mixtures., Results: Nuclear magnetic resonance studies show that the use of ultrasonics resulted in increased chemical degradation of NaOCl as compared to the SAF system and non-agitated samples. The prevalence of chemical activation in the ultrasonic group over the SAF group was almost 3 times higher, 3.11 to 1.20, respectively. The Kruskal-Wallis rank sum test revealed there is a statistically significant difference in distributions between the groups., Conclusions: Both SAF and ultrasonics activate NaOCl. Ultrasonic agitation provided higher chemical activation of NaOCl solution than the SAF. The use of ultrasonic agitation of NaOCl in endodontic treatment will allow us to obtain better long-term clinical results.

Objective: The purpose of this study was to compare the efficacy of different irrigation protocols on smear layer removal in root canals of primary teeth by scanning electron microscopy (SEM)., Material and Methods: The study was conducted with 40 extracted maxillary primary incisor teeth divided into four groups (n = 10) as 1% sodium hypochlorite (NaOCl), 10% ethylenediaminetetraacetic acid (EDTA)+1% NaOCl, 6% citric acid (CA)+1% NaOCl, and 0.9% physiological saline (PS). After the irrigation procedures, root canal walls were examined by SEM and the efficacies of irrigation solutions in smear layer removal were scored and compared. Data were analyzed using Kruskal-Wallis, Friedman and Siegel Castellan tests., Results: The smear layer removal was found to be statistically more effective in groups of 10% EDTA + 1% NaOCl and 6% CA + 1% NaOCl when compared with the other groups (p < .05). Smear removal efficacy was statistically significantly higher in coronal and medium thirds when compared with the apical regions in the experimental groups., Conclusions: It was concluded that 10% EDTA + 1% NaOCl and 6% CA + 1% NaOCl could be alternative irrigation protocols regarding smear layer removal. However, due to the absence of erosive dentinal changes, it might be suggested that using 6% CA + 1% NaOCl can be recommended compared to 10% EDTA + 1% NaOCl in primary root canals.

This study indented to assess the clinical and radiographic assessment of Allium sativum extract as an intracanal irrigant for pulpectomy of primary molars. Ninety children with 110 teeth submitted were categorized into two groups. Clinical and radiographic success rates were checked at 3, 6, and 12 months. Qui-square test at a level of significance was ˂0.05. There was no statistically significant difference ( p  ˂ .05) between the two groups that has not been detected clinically or radiographically. Clinical and radiographic success rates of garlic extract at 3 months were (80% and 72.7%), which declined at 6 and 12 months to be 76.4% 6 and 74.5% respectively. For NaOCl group, clinical and radiographic success rates were 87.3% and 85.5% at 3 months, 87.3% and 87.3% at 6 months and 89.1% and 87.3% at 12 months. A. sativum extract can be used efficiently as an irrigant for pulpectomy of primary molar root canals., Competing Interests: None declared.

To compare the smear layer removal ability and mineral content of root canal dentine after initial irrigation with NaOCl and final irrigation with MTAD, QMix, and 17% EDTA. Forty extracted human maxillary incisors before root canal preparation and irrigation with NaOCl were randomly divided into four groups (n = 10) according to the type of final irrigants used: MTAD, QMix, 17% EDTA, and control (sterile distilled water). Scanning electron microscopy (SEM) was used to assess the presence of smear layer. SEM energy-dispersive X-ray spectroscopy was used to quantify dentin mineral composition in MTAD, QMix, 17% EDTA group, and in no-treatment samples (no-treatment group; n = 10). Among the various chelating agents, there were no significant differences in the smear layer removal in the middle and coronal thirds (p > .05). In the apical third, QMix removed significantly more smear layer than 17% EDTA (p < .05), but similarly to MTAD (p > .05). Final irrigation with MTAD resulted in a significant increase in the carbon (C) value compared to EDTA (p < .001). There was no significant difference in the mineral composition between the MTAD and the QMix group, although the values of the mineral elements were significantly altered in the MTAD group. QMix had smear layer removal capability similar to MTAD but better than EDTA in the apical third. MTAD yielded the most pronounced effect on mineral component of root dentin; however, differences were significant only for C level compared to 17% EDTA., (© 2019 Wiley Periodicals, Inc.)

Given the increasing prevalence of antibiotic resistance among bacterial strains and the side effects caused by synthetic drugs, it is increasingly important to investigate potential herbal alternatives. In the present study, antimicrobial, cell cytotoxicity, and cleaning tests were performed to evaluate the potential of Fufang Bingpeng irrigant as a root canal irrigant, in addition to q-PCR and high-throughput sequencing analyses. Our in vitro results showed a low minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of Fufang Bingpeng irrigant against Porphyromonas gingivalis ATCC 33277 (6.25 and 12.5%, respectively), Prevotella intermedius ATCC 25611 (6.25 and 6.25%, respectively), Fusobacterium nucleatum ATCC 25286 (6.25 and 6.25%, respectively), Enterococcus faecalis ATCC 19433 (25 and 25%, respectively), and Bacteriodes fragilis ATCC 25285 (12.5 and 12.5%, respectively). Furthermore, it effectively removed the remaining debris and increased the number of open dentinal tubules in root canals compared to the NaCl irrigant ( p < 0.05). Fufang Bingpeng irrigant also presented low cytotoxicity to L929 cells compared to the NaClO irrigant. The in vivo results indicated that all irrigants used significantly reduced the number of bacteria compared to the number prior to treatment, and only 1/104.95 bacteria remained in the root canal following the use of Fufang Bingpeng irrigant ( p < 0.001). Moreover, the high-throughput sequencing results indicated that all irrigants markedly enhanced the α diversity in the root canal compared to the before preparation control group, while Fufang Bingpeng maintained better microbial diversity than other groups. Therefore, Fufang Bingpeng irrigant presents a promising alternative for use as a root canal irrigant in clinical settings.

Introduction: An early-stage decision clinicians often make in the management of complex wounds is which method of wound preparation will be appropriate for the patient. This decision can be affected by numerous wound and patient risk factors that present challenges and may make surgical debridement difficult in patients with complex wounds. Recently, negative pressure wound therapy with instillation and dwell time (NPWTi-d) using a novel reticulated open-cell foam dressing with through holes (ROCF-CC) was shown to aid in the loosening and removal of thick exudate and nonviable tissue from wounds., Objective: The authors present their experiences of using NPWTi-d with ROCF-CC, along with rationales for wound care decisions., Materials and Methods: Patients received antibiotics and surgical debridement when appropriate. Therapy selection and parameters were based on a decision-tree model for wound care management that takes into consideration patient and wound information. Most patients received NPWTi-d with ROCF-CC for a duration of 5 to 8 days; however, 1 patient received NPWTi-d with ROCF-CC for more than 30 days due to the wound extent and severity. Therapy consisted of instilling saline or quarter-strength sodium hypochlorite solution with dwell times of 3 to 10 minutes, followed by 2 hours or 3.5 hours of NPWT either at -100 mm Hg or -125 mm Hg., Results: There were 6 patients (3 men, 3 women; average age, 58.5 years) treated. Wound types included 3 pressure ulcers, 1 necrotizing soft tissue infection, 1 perianal abscess, and 1 large abdominal wound. Patient comorbidities included obesity, type 2 diabetes, and radiation therapy. In all cases, progression of wound healing was observed with no complications. This method produced viable granulation tissue and wound bed preparation; however, patients were not followed to closure or grafting., Conclusions: These cases help support the use of NPWTi-d with ROCF-CC as a viable option for wound care providers in the early-stage management of complex wounds.

The emergence of methicillin-resistant Staphylococcus pseudintermedius has increased the interest in topical therapy for treating canine pyoderma. Shampooing with chlorhexidine followed by dilute bleach rinses are often recommended, but household bleach can dry the skin and is unpleasant to use. A shampoo formulated with sodium hypochlorite and salicylic acid was evaluated as sole therapy for dogs with superficial pyoderma associated with S. pseudintermedius , including methicillin-resistant strains. Client-owned dogs were recruited based on positive culture for methicillin-resistant staphylococci or prior failure of pyoderma to respond to antibiotics. This prospective, open-label pilot study assessed the efficacy of the shampoo when used three times weekly for 4 wk. Dogs were evaluated at baseline and at 2 and 4 wk by cytology, clinical examination, and owner assessment. Digital images were also obtained. Baseline bacterial counts, clinical assessments and owner scores were significantly improved at 2 and 4 wk. Clients completing the study reported excellent lathering and dispersion, reduction in odor, and brightening of white and light coats. No owners reported skin dryness or other adverse events during the study. We conclude that this shampoo containing sodium hypochlorite in a vehicle that avoids skin drying is an effective treatment for canine pyoderma.

Introduction: The aim of this study was to evaluate the effect of 2 different concentrations of sodium hypochlorite on healing and postoperative pain after primary endodontic treatment., Methods: One hundred mandibular molars with pulp necrosis and chronic apical periodontitis were randomly assigned to 2 treatment groups: high-concentration (HC) 5% sodium hypochlorite and low-concentration (LC) 1% sodium hypochlorite. Root canal treatment was performed using a standardized protocol. Canals were prepared using equal volumes of respective irrigants after each instrument change. After chemomechanical preparation, the final flush was performed with 5 mL 17% EDTA solution followed by 5 mL 5% or 1% sodium hypochlorite depending on the group. All patients were asked to record the degree of pain on a visual analog scale every 24 hours for 1 week. At the second visit, canals were obturated, and the teeth were restored permanently. Clinical and radiographic evaluations were performed every 3 months for 12 months. The data collected were statistically analyzed., Results: Eighty-six teeth were available for evaluation at the 1-year follow-up. The overall healing rate observed was 76.7%. Greater healing was observed in the HC (81.4%) group compared with the LC group (72.1%), but the difference was not statistically significant (P > .05). No significant differences in pain incidence and pain scores were found between the 2 groups (P >.05), with lower values reported in the LC group., Conclusions: The use of LC or HC sodium hypochlorite did not result in a significant difference in the clinical outcome., (Copyright © 2019 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this randomized clinical study was to evaluate the effect of laser-activated irrigation using a photon-induced photoacoustic streaming (PIPS) technique on postoperative pain following completion of root canal obturation. Methods: Fifty-six patients were enrolled in this randomized clinical trial. Fifty-six healthy premolars or molars with asymptomatic irreversible pulpitis, symptomatic irreversible pulpitis, or symptomatic pulpal necrosis, with or without apical periodontitis, were mechanically prepared for endodontic treatment and divided into two groups. Patients were randomly allocated to treatment groups. In the positive control group G1, the final irrigation with 2 cc of 5.25% sodium hypochlorite (NaOCl) was achieved using a 27G needle, introduced into the canal to a distance of 5 mm from the predetermined working length. In the experimental group G2, the root canals were irrigated with 17% ethyldiamine tetric acid (EDTA) and 5.25% NaOCl following the PIPS protocol, using an Er:YAG 2940 nm laser (LightWalker ATS ® ; Fotona, Slovenia) with a 600 μm diameter tip and operating parameters of 20 mJ per pulse, 15 Hz frequency, 0.3 W average power, and a 50-μs pulse duration. Postoperatively, the patients were advised to take a minor analgesic (ibuprofen 400 mg) in the event of pain perception. Postoperative pain levels were assessed after 24, 48, and 72 h and 7 days through the use of a Visual Analogue Scale questionnaire, completed by each patient. Data were analyzed using Kolmogorov-Smirnov, Fisher Exact, Chi square, Mann-Whitney test, and Friedman's test. The level of significance was set at α = 0.05. Results: There was no significant difference between the laser-irradiated group and the control group ( p  < 0.5). Laser activation of irrigating solutions did not increase postoperative pain. Conclusions: The outcome of this investigation indicated that PIPS was as effective as conventional irrigation in relation to postoperative pain, making this activation technique interesting to use for supplementary root canal disinfection.

Aim: To investigate whether a minimally invasive basic root canal preparation technique has an influence on root canal cleanliness in extracted mandibular molar teeth., Methodology: A total of 80 root canals (40 mesio-buccal and 40 mesio-lingual) from 40 mandibular molars were included. The teeth were divided equally into four different experimental groups depending on the subsequently root canal preparation technique: Group 1: a basic preparation was performed up to size 20, .04 taper; Group 2: a basic preparation was performed up to size 2, .06 taper; Group 3: a basic preparation was performed up to size 25, .04 taper; and Group 4: a basic preparation was performed up to size 25, .06 taper. After the use of each instrument, each root canal was irrigated with 2.5 mL of 6% sodium hypochlorite for 30 s. Then, 1 mL NaOCl was activated for 20 s using an EDDY sonic tip. Final irrigation was performed using a total of 5 mL of 17% EDTA solution. The roots were then split longitudinally and all root canal thirds were observed through scanning electron microscopy (SEM) to evaluate the presence of superficial debris and smear layer using a scoring system. Data were statistically analysed using the Kruskal-Wallis and Bonferroni tests with a level of significance set at P < 0.05., Results: In all groups, there was significantly more residual debris and smear layer in the apical third (P < 0.05), with no differences between the middle and coronal thirds (P > 0.05). For both the parameters analysed, there was no difference amongst the groups in the middle and coronal thirds (P > 0.05), whilst in the apical third significantly less debris and smear layer was found in specimens from groups 3 and 4 than for groups 1 and 2 (P < 0.05)., Conclusion: All basic root canal preparation techniques were associated with less debris and smear layer on the canal walls in the middle and coronal thirds, without differences among them. Even though debris and smear layer were always present in the apical third, an apical size of 25 resulted in significantly cleaner canals walls compared to a size 20., (© 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

We describe complete healing of an extensive cystic lesion by using a conservative approach: root canal treatment with concurrent surgical drainage. A silicone Foley catheter drain was modified into a surgical drainage stent, which was then used for 4 weeks. Disinfection of the root canal was achieved by the use of hand files and irrigation with 5.25% NaOCl for a minimum of 30 minutes. The irrigant changes were performed at 5-minute intervals, and no intracanal dressing was used. At subsequent follow-up examinations, cone-beam computed tomography and periapical radiographs confirmed that complete healing had occurred around the periapical and lateral areas of affected teeth. This case report indicates the potential for healing of large cystic lesions by nonsurgical root canal treatment., (Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Aim: To determine the free available chlorine of 2.5% sodium hypochlorite (NaOCl) alone and combined with 9% etidronic acid (HEDP) in the presence of inhibitors, organic tissue and organic tissue plus dentine debris; to evaluate the influence of dentine debris on the tissue-dissolving capacity of both NaOCl solutions; and to determine the antimicrobial action of these solutions when in contact with organic tissue and organic tissue plus dentine debris., Methodology: The available chlorine of the solutions over time in the absence and presence of the inhibitors was measured using a titration method. The organic tissue dissolution by the solutions alone and in the presence of dentine powder was evaluated by weighing bovine tissue specimens before and after exposure to the solutions for 3 and 10 min. For the antimicrobial activity, biofilms of Enterococcus faecalis were exposed to the solutions for 3 min in the absence and presence of organic tissue and organic tissue + dentine debris. The biovolume and percentage of damaged membrane cells of the biofilm were measured by means of confocal microscopy and the live/dead technique. Nonparametric tests were used to determine statistical differences (P < 0.05)., Results: Both inhibitors consumed the free available chlorine of the solutions over time. The presence of dentine debris significantly reduced the tissue dissolution capacity of the NaOCl solutions (P < 0.05). The percentages of biovolume reduction were not affected by the presence of the inhibitors in the two NaOCl solutions, whereas the percentage of damaged membrane cells was significantly reduced (P < 0.001). Overall, a similar behaviour was observed in the NaOCl and NaOCl/HEDP groups., Conclusions: The presence of organic tissue and organic tissue + dentine debris favoured rapid consumption of the free chlorine of NaOCl and NaOCl/HEDP. This resulted in a decreased ability to dissolve organic tissue without affecting the short-term antimicrobial activity., (© 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

The aim of this study was to evaluate whether amplifying the volume and/or time of contact of NaOCl affects the fracture strength of endodontically treated bovine teeth. Four bovine incisors from 10 animals were allocated into 4 groups using a split-mouth design. Root canals were instrumented using a sequence of 4 manual stainless steel files and irrigated with a 5.25% alkalized NaOCl solution. The total volume and time of irrigation, per sample, varied among the groups as following: standard volume and time of contact - 15 mL/11.5 min; volume raise - 30 mL/11.5 min; time of contact raise - 15 mL/19 min; and volume and time of contact raise - 30 mL/19 min. Samples were subjected to a fracture resistance assay. At p=0.05, two-way ANOVA statistically scrutinized the results. Effect size of NaOCl time of contact and volume were also calculated (η2). The variation in time (p=0.000), volume of irrigation (p=0.000) and the combination of both (p=0.038) negatively influenced the fracture resistance. Standard volume and time of irrigation showed the highest fracture strength while isolated increase in volume or time reduced in 25% and 37%, respectively, the fracture resistance; the simultaneous increase in volume and time of irrigation promoted a reduction of 47%. Effect size of NaOCl time of contact was superior (0.746) than the volume (0.564). Raising the volume and/or time of a 5.25% alkalized NaOCl solution reduces the fracture resistance of endodontically treated bovine teeth.

Background/objectives: Skin infection is common in atopic dermatitis (AD), often necessitating treatment with systemic antibiotics. Topical adjunctive therapies such as dilute bleach baths are increasingly recommended, and topical dilute acetic acid (AA) has not been widely studied. The objective of this study was to evaluate whether various topical anti-infective bathing recommendations were associated with decreased systemic antibiotic exposure in pediatric AD, as well as evaluate topical anti-infective recommendations over time within our institution., Methods: Clinical data were extracted from charts of pediatric patients from 1/1/2000 to 12/31/2005 and 1/1/2009 to 12/31/2014 who visited outpatient dermatology clinics at Mayo Clinic, Rochester, a tertiary referral center. Recommendations for topical anti-infectives (dilute AA, dilute bleach, other, or none) at any time after patient had clinically proven or suspected AD superinfection were recorded as exposures to topical anti-infective. Primary outcome was the number of systemic antibiotic courses in a 1-year period., Results: Of 1111 patients with AD, 753 met inclusion criteria (303 in 2000-2005; 450 in 2009-2014). Of these, 351 (46.6%) had culture-proven or clinically suspected superinfection. Topical anti-infective recommendations increased between the time periods (23.3% to 79.2%; P < 0.001) and number of courses of systemic antibiotics decreased (1.9 per year vs 1.5 per year, P = 0.010). Number of systemic antibiotic courses did not differ between those who received bathing recommendations and those who did not, nor between different anti-infective groups (P = 0.398)., Conclusions: Practice behaviors have changed, and topical anti-infectives are now commonly recommended. Neither dilute AA nor bleach baths were associated with fewer subsequent exposures to systemic antibiotics in the treatment of pediatric AD., (© 2018 Wiley Periodicals, Inc.)

Introduction: The present study aimed to evaluate the antibacterial effect of a new peptide, DJK-5, used alone or mixed together with EDTA on mono- and multispecies biofilms in dentin canals covered by a smear layer with or without preceding sodium hypochlorite (NaOCl) irrigation., Methods: One hundred twelve dentin blocks (224 final specimens) were prepared and divided into 56 groups, and Enterococcus faecalis or multispecies bacteria were introduced into dentinal tubules by centrifugation. After 1 week of cultivation, a uniform smear layer was created on the surface of the dentin blocks, and the samples were exposed to sterile water, 17% EDTA, 2% or 6% NaOCl, 10 μg/mL DJK-5, or a mixture of 8.5% EDTA +10 μg/mL DJK-5 or were combined treated with the solution in the following sequence: 2% or 6% NaOCl +10 μg/mL DJK-5, 2% or 6% NaOCl + 8.5% EDTA +10 μg/mL DJK-5, 2% or 6% NaOCl + 8.5% EDTA + 10 μg/mL DJK-5. Specimens without a smear layer treated by 6% NaOCl or 10 μg/mL DJK-5 served as the positive control. The irrigant exposure time was 3 or 10 minutes. The antibacterial efficacy was determined by live/dead staining and confocal laser scanning microscopy., Results: The smear layer reduced the antibacterial capacity of 6% NaOCl and 10 μg/mL DJK-5. The efficacy of 2% or 6% NaOCl followed by 10 μg/mL DJK-5 was superior to 10 μg/mL DJK-5 alone (P < .05) but inferior to 2% or 6% NaOCl + 8.5% EDTA + 10 μg/mL DJK-5 and 2% or 6% NaOCl + 8.5% EDTA + 10 μg/mL DJK-5 (P < .05). The mixture of 8.5% EDTA and 10 μg/mL DJK-5 had the same disinfection effectiveness as 10 μg/mL DJK-5 used alone (P < .05). Using 2% or 6% NaOCl before EDTA + peptide always resulted in the highest killing (P < .05)., Conclusions: The smear layer inhibits the disinfectant effect in dentin. Peptide DJK-5 showed a strong antibacterial effect against mono- and multispecies biofilms in dentin canals. The highest killing was measured when 6% NaOCl was followed by a mixture of EDTA and peptide DJK-5., (Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to compare antibacterial and smear layer removal efficacy of the erbium:yttrium-aluminium-garnet (Er:YAG) laser irradiation by photon-induced photoacoustic streaming (PIPS), neodymium:yttrium-aluminium-garnet (Nd:YAG), and diode lasers and conventional irrigation agent in primary molar root canals., Background: The selection, application, and activation of the irrigant are important factors affecting the success of the endodontic treatment., Materials and Methods: Distal root canals of human primary mandibular molar teeth used for antimicrobial efficacy evaluation were first inoculated with Enterococcus faecalis (n = 25). Smear layer removal efficacy was evaluated on the noninoculated specimens (n = 20). The root canals in the first treatment groups were irrigated with a conventional technique using 5% sodium hypochlorite (NaOCl). In the laser groups, the root canals were irradiated with either Nd:YAG (1064 nm) or diode lasers (940 nm) followed by NaOCl irrigation agent. In the fourth groups, the NaOCl irrigation agent was activated with an Er:YAG laser (2940 nm) by PIPS tip using nonablative settings. Antibacterial efficacy was determined by viable counts of E. faecalis after treatments. The treated root canals were examined by scanning electron microscopy to determine the smear layer removal efficacy of treatments., Results: Statistically significant (p < 0.05) reductions in the number of E. faecalis were achieved in Nd:YAG and diode laser groups and Er:YAG laser by PIPS-activated irrigation groups compared to the NaOCl group. Er:YAG laser by PIPS-activated irrigation resulted in more cleaning of the root canal walls and a higher quantity of open tubules., Conclusions: These findings suggest that Er:YAG laser by PIPS-activated irrigation can be considered as an effective irrigant agitation technique in pediatric endodontics.

Objective: To compare the frequency of pain in root canal treatment using sodium hypochlorite and chlorhexidine as root canal irrigants., Methods: The cross-sectional study was carried out from January to June 2016 at the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan, and comprised patients aged 18-40 years with irreversible pulpitis involving a posterior tooth. The patients were divided into two equal groups, with Group-I receiving 2% chlorhexidine, and Group-II receiving 5.25% sodium hypochlorite. Following the use of the irrigants, the selected teeth were evaluated for pain at 72 hours using Visual Analogue Scale., Results: There were 60 patients divided into groups of 30(50%) each. The overall mean age was 27.97±5.9 years. There were 32 (53.3%) females and 28 (46.6%) males. The mean post-operative pain score was 1.70±1.9 in Group-I and 1.90 ± 2.3 in Group-II (p=0.5). In Group-I, 25(83.3%) patients had no pain while in Group-II, 20(66.7%) had no pain (p=0.1)., Conclusions: There was no difference in post-operative pain at 72 hours between 2% chlorhexidine and 5.25% sodium hypochlorite when used as irrigants.

Aims: The aim of the present study was to evaluate the efficacy of reverse rotary instrumentation in disinfection of the root canal at the apical third and qualitative confirmatory analysis using the scanning electron microscope (SEM)., Subjects and Methods: Sixty single-rooted mandibular premolars were instrumented up to Protaper rotary file size F2 and contaminated with a known species of Enterococcus faecalis (ATCC 29212). The samples were then divided into three groups; Group 1: Experimental group-irrigation by agitation of 1% NaOCl with reverse rotary instrumentation; Group 2: Negative control-no irrigation; and Group 3 positive control-irrigation with 1% NaOCl using a 30-gauge needle. The colony forming units of all the groups were checked. SEM analysis of the samples was focused on the apical third to confirm the absence of E. faecalis biofilms. The data obtained were statistically analyzed by the Fisher's exact test and Pearson's Chi-square test., Results: Group I and III showed significant reduction in the growth of E. faecalis (P ≤ 0.001). SEM confirmed dense bacterial colonies in the Group II consistent with biofilm formation and reduction in bacterial colonies in Group I and II., Conclusion: Agitation with reverse rotary instrumentation in the apical third of the root canal along with 1% sodium hypochlorite proved effective in disinfection of the apical third of the root canal, which was further confirmed by scanning electron microscopic analysis. Hence, it can be used as an adjunct during rotary instrumentation in efficient cleansing of the root canal system in the apical third of the root canal system., Competing Interests: There are no conflicts of interest

Objective: The aim of this study was to compare the bactericidal effect of various laser irradiation systems on Enterococcus faecalis biofilms in dentinal tubules by using a novel dentin infection model and confocal laser scanning microscopy (CLSM)., Background Data: Laser-activated irrigations have been proposed as an adjuvant to conventional protocols of root canal treatment to enhance the smear layer removal, which is a promising protocol for root canal disinfection., Materials and Methods: E. faecalis were centrifuged into the dentinal tubules, cultured for 3 weeks, and then received 1- and 3-min treatments as follows: (A) 5.25% sodium hypochlorite (NaOCl) irrigation, (B) Nd:YAG laser irradiation, (C) diode laser irradiation, (D) Nd:YAP laser irradiation, (E) Er,Cr:YSGG laser-activated NaOCl irrigation, and (F) Er:YAG laser-activated NaOCl irrigation. Bacterial reductions were assessed by CLSM using a LIVE/DEAD ® bacterial viability stain method., Results: For each group, the bacterial reduction increased as the treatment time increased (p < 0.05). The Er,Cr:YSGG and Er:YAG laser significantly enhanced the bactericidal effect of NaOCl (p < 0.05). Under the conditions of the same treatment time, bacterial reductions were presented in the descending order of Er:YAG + NaOCl, Er,Cr:YSGG + NaOCl > Nd:YAP > Nd:YAG, diode > NaOCl., Conclusions: Under the conditions of present study, treatments of Er:YAG + NaOCl and Er,Cr:YSGG + NaOCl presented the strongest bactericidal effect among the tested protocols and are potential protocols for root canal disinfection.

Dakin's solution and the Carrel-Dakin method were developed and integrated into clinical practice in the early 20th century, which were found to aid in effective wound healing and infection. This historical review briefly outlines highlights with regard to the history of infection management, wartime amputation, and wound treatment dating back to Galen through the early 20th century. This paper extensively reviews and discusses the historic use of Dakin's solution, which was developed almost a century ago, in both wartime settings and in the civilian sector as well. This review further elaborates on the use of Dakin's solution in the current treatment of wounds in the United States. Additionally, we discuss the history of wound care with the emphasis on the Carrel-Dakin method. Finally, this review discusses and presents contemporary application and utilization of Dakin's solution in two large tertiary care centers., (Copyright © 2018. Published by Elsevier Ltd.)

Background: The hospital environment is a source of pathogen transmission. The effect of enhanced disinfection strategies on the hospital-wide incidence of infection has not been investigated in a multicentre, randomised controlled trial. We aimed to assess the effectiveness of four disinfection strategies on hospital-wide incidence of multidrug-resistant organisms and Clostridium difficile in the Benefits of Enhanced Terminal Room (BETR) Disinfection study., Methods: We did a prespecified secondary analysis of the results from the BETR Disinfection study, a pragmatic, multicentre, crossover cluster-randomised trial that assessed four different strategies for terminal room disinfection in nine hospitals in the southeastern USA. Rooms from which a patient with a specific infection or colonisation (due to the target organisms C difficile, meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci (VRE), or multidrug-resistant Acinetobacter spp) was discharged were terminally disinfected with one of four strategies: standard disinfection (quaternary ammonium disinfectant, except for C difficile, for which 10% hypochlorite [bleach] was used; reference); standard disinfection and disinfecting ultraviolet light (UV-C), except for C difficile, for which bleach and UV-C was used (UV strategy); 10% hypochlorite (bleach strategy); and bleach and UV-C (bleach and UV strategy). We randomly assigned the sequence of strategies for each hospital (1:1:1:1), and each strategy was used for 7 months, including a 1-month wash-in period and 6 months of data collection. The prespecified secondary outcomes were hospital-wide, hospital-acquired incidence of all target organisms (calculated as number of patients with hospital-acquired infection with a target organism per 10 000 patient days), and hospital-wide, hospital-acquired incidence of each target organism separately. BETR Disinfection is registered with ClinicalTrials.gov, number NCT01579370., Findings: Between April, 2012, and July, 2014, there were 271 740 unique patients with 375 918 admissions. 314 610 admissions met all inclusion criteria (n=73 071 in the reference study period, n=81 621 in the UV study period, n=78 760 in the bleach study period, and n=81 158 in the bleach and UV study period). 2681 incidenct cases of hospital-acquired infection or colonisation occurred during the study. There was no significant difference in the hospital-wide risk of target organism acquisition between standard disinfection and the three enhanced terminal disinfection strategies for all target multidrug-resistant organisms (UV study period relative risk [RR] 0·89, 95% CI 0·79-1·00; p=0·052; bleach study period 0·92, 0·79-1·08; p=0·32; bleach and UV study period 0·99, 0·89-1·11; p=0·89). The decrease in risk in the UV study period was driven by decreases in risk of acquisition of C difficile (RR 0·89, 95% CI 0·80-0·99; p=0·031) and VRE (0·56, 0·31-0·996; p=0·048)., Interpretation: Enhanced terminal room disinfection with UV in a targeted subset of high-risk rooms led to a decrease in hospital-wide incidence of C difficile and VRE. Enhanced disinfection overcomes limitations of standard disinfection strategies and is a potential strategy to reduce the risk of acquisition of multidrug-resistant organisms and C difficile., Funding: US Centers for Disease Control and Prevention., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The aim of this study was to evaluate the cytotoxic effects of 2. 5% sodium hypochlorite (NaOCl), 17% ethylenediamine tetraacetic acid (EDTA), and 1% peracetic acid (PAA) on human fibroblasts. FG11 and FG15 cell lines were cultured in 24-well cell culture plates for cell proliferation assessment and 96-well cell culture plates for the methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay; Dulbecco's modified Eagle's medium (DMEM) was used as control data. The experimental solutions were used at 0. 01%, 0. 05%, and 0. 1% dilutions and assessed at 1-, 2-, and 4-hour intervals. Data were subjected to statistical analysis by two-way analysis of variance (ANOVA), followed by the Bonferroni test at a significance level of p <0. 05. The assessment of cell proliferation in this study showed cytotoxicity to the fibroblasts with 2. 5% NaOCl for all three dilutions at all time intervals, 17% EDTA for the 0. 05% and 0. 1% dilutions at the 2- and 4-hour intervals, and 1% PAA for all three dilutions at the 4-hour interval. The cell viability assay (MTT assay) for fibroblasts showed 2. 5% NaOCl to be cytotoxic at the 0. 05% and 0. 1% dilutions at all time intervals, 17% EDTA to be cytotoxic at the 0. 1% dilution at the 2- and 4-hour intervals, and 1% PAA to be cytotoxic at the 0. 1% dilution at the 2- and 4-hour intervals. In conclusion, 1% PAA was less cytotoxic than 2. 5% NaOCl and 17% EDTA., (Sociedad Argentina de Investigación Odontológica.)

Background: Many studies have investigated the effectiveness of root canal irrigants and medicaments against Enterococcus faecalis. The aim of this study was to compare the efficacy of commonly used medicaments against E. faecalis cultured as a biofilm on dentine substrate., Methods: An E. faecalis biofilm was established on human dentine slices using a continuous flow cell. Each test medicament (Ledermix, Ca(OH) 2 , Odontopaste, 0.2% chlorhexidine and 50:50 combinations of Ledermix/Ca(OH) 2 and Odontopaste/Ca(OH) 2 ) was introduced into the flow cell and biofilms were harvested and quantitated by determining cellular protein. Cellular viability was determined using serial plating and the number of colony-forming units was normalized against cellular protein to allow treatment protocols to be compared. Qualitative scanning electron microscopy analyses of the biofilm were performed after a 48-h exposure to each test agent., Results: Sodium hypochlorite achieved total bacterial elimination. Ledermix and Odontopaste had no significant effect on the E. faecalis biofilm. Ca(OH) 2 and 50:50 combinations of Ca(OH) 2 /Ledermix or Ca(OH) 2 /Odontopaste reduced the viability by more than 99% while 0.2% chlorhexidine reduced bacterial numbers by 97%., Conclusions: Sodium hypochlorite remains the gold standard for bacterial elimination in root canal therapy. However, Ca(OH) 2 in isolation and combined with Ledermix, and Odontopaste was highly effective in reducing bacterial viability., (© 2017 Australian Dental Association.)

Individuals with atopic dermatitis (AD) have used bleach baths to treat superinfections, although their mechanism of action is not well understood. The ClinicalTrials.gov, National Eczema Association, and PubMed databases were searched for studies that investigate the role bleach plays in modulating AD. Fifteen studies were included in this review. Bleach bath improves clinical symptoms of AD and restores surface microbiome by eradicating bacteria, most notably Staphylococcus aureus. Many studies have noted that this antimicrobial effect has reduced the need for topical corticosteroids or topical antibiotics. In addition, bleach seems to have strong anti-inflammatory and antipruritogenic effects. Lastly, bleach baths seem to be safe on human skin, without disrupting epidermal barrier function. Although the effects of bleach are promising, studies that investigate the long-term use of bleach alone, without concomitant AD treatment modalities, are needed. The emergence of new bleach-containing products warrants future investigations to examine their effects on cutaneous microbiome, epidermal barrier function, and immunity.

Background: Transmission of healthcare-associated infections caused by antibiotic- and multi-drug resistant (MDR) pathogens (e.g. Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa ) are a major concern in patient care facilities. Disinfectant usage is critical to control and prevent pathogen transmission, yet the relationships among strain, disinfectant type, contact time, and concentration are not well-characterized. We hypothesized that there would be significant differences in disinfectant efficacy among clinically relevant strains under off-label disinfectant conditions, but there would be less no differences among at registered label use concentrations and contact times. The purpose of this study was to quantify the effect of disinfectant concentration and contact time on the bactericidal efficacy of clinically relevant strains of S. aureus and P. aeruginosa ., Methods: Accelerated hydrogen peroxide (AHP), quaternary ammonium compounds (Quat), and sodium hypochlorite were tested at label and reduced contact times and concentrations against four MDR P. aeruginosa strains and four MRSA strains. Quantitative EPA method MB-25-02 was used to measure disinfectant efficacy reported as log 10 reduction., Results: Both off-label disinfectant concentrations and contact times significantly affected efficacy of all disinfectants tested. Bactericidal efficacy varied among MRSA and P. aeruginosa strains., Conclusions: The quantitative disinfectant efficacy method used highlights the inter-strain variability that exists within a bacterial species. It also underscores the need for a disinfectant validation method that takes these variances into account., Competing Interests: Not applicable.Not applicable.PT reports grants from Diversey Inc., during the conduct of the study; personal fees from Diversey Inc., outside the submitted work. HO, AW, and CL all report grants from Diversey Inc., during the conduct of the study.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Objectives: This is to compare the volumes of irrigant apically extruded by five irrigation systems in an artificial socket model simulating clinical conditions., Materials and Methods: Twenty extracted human single-rooted teeth were enlarged to size 40/04 and then embedded in silicone impression material. The root canal space was irrigated with nominal 3% sodium hypochlorite (NaOCl) using standard needle irrigation (SNI) with a 30-gauge notched needle, EndoActivator (EA), XP Endo Finisher (XP Endo), EndoVac (EV), and photon-induced photoacoustic streaming (PIPS). Extruded NaOCl was collected, reacted with taurine to form taurine-monochloramine, and absorbance of taurine-monochloramine was measured at 252 nm using a spectrophotometer. The five irrigation systems were compared with repeated measures ANOVA and pairwise comparisons., Results: The EV group had very low extrusion (mean ± SD = 0.12 ± 0.2 μL) and differed significantly from the other four groups (P ≤ 0.001). Larger volumes of irrigant were extruded in the other irrigation groups. There were no significant differences in the extruded volumes among the SNI (7.4 ± 3.4 μL), EA (7.0 ± 6.1 μL), and XP Endo (7.8 ± 4.1 μL) groups (P = 1). The PIPS group had the highest mean extruded volume (12.9 ± 6.8 μL) and differed significantly from SNI (P = 0.030), EV (P < 0.0005), and EA (P = 0.02), but not XP Endo (P = 0.154)., Conclusion: Under the in vitro conditions of this study, irrigant extrusion appears unavoidable unless negative pressure irrigation such as EV is used. PIPS extrudes more irrigant than other systems, while SNI, EA, and XP Endo extrude similar volumes of irrigant., Clinical Relevance: The findings help clinicians select the optimal irrigation system to avoid irrigant extrusion.

This study evaluated the amount of apically extruded debris after chemo-mechanical preparation (CMP) using positive and negative pressure irrigation systems [Conventional irrigation (CI) and EndoVac (EV)] in association with different irrigants [6% Sodium Hypochlorite (NaOCl), 2% Chlorhexidine gel + saline solution (CHXg + SS), 2% Chlorhexidine solution (CHXs) or Saline solution (SS)]. Eighty mandibular premolars with single root canals were selected and randomly assigned into 8 groups (n = 10) according to the irrigation system and the irrigant used during CMP: G1 (EV + NaOCl), G2 (EV + CHXg + SS), G3 (EV + CHXs), G4 (EV + SS), G5 (CI + NaOCl), G6 (CI + CHXg + SS), G7 (CI + CHXs) and G8 (CI + SS). Reciproc® R25 files (25/.08) were used during the CMP and the extruded debris from each tooth was collected in pre-weighted Eppendorf tubes and dried. The average weight of debris was assessed using a microbalance, and the data were statistically analyzed using ANOVA and the post hoc Tukey's test (a = 0.05). All groups were associated with debris extrusion. EV was the irrigation system with less extruded debris (p < 0.05). No differences were observed regarding the irrigant when EV was used. When CI was used, CHXg + SS were associated with lower debris extrusion (p < 0.05). It was concluded that no irrigation protocol succeeded in preventing debris extrusion. EV resulted in lower levels of debris extrusion than CI. The use of CHXg + SS resulted in lower debris extrusion.

Introduction: This article reports for the first time the effects of multiple additives (polyethylene glycol 400, Triton X-100, benzalkonium chloride, and ethyl formate) on the surface tension, pH, and viscosity of 5.25% sodium hypochlorite (NaOCl) irrigant solution. Advanced statistical approaches based on unsupervised multivariate analysis (cluster analysis and principal component analysis) were used to quantify the variability of the physicochemical properties of the modified NaOCl solution for the first time in dentistry., Methods: Solutions of 5.25% NaOCl were modified with multiple additives in various concentrations, physicochemical parameters were measured at 22°C and 37°C, and the results were statistically analyzed to group the solutions and reveal the effects of additives., Results: Cluster analysis and principal component analysis revealed that pH and surface tension were the significant parameters (P < .05) for grouping the modified solutions. Four principal components, accounting for 90.6% of the total variance, were associated with flow characteristics (37.3%) determined by polyethylene glycol; the wetting property (22.5% and 10.5%), which was dependent on cationic and nonionic surfactant; and the antimicrobial effect (20.3%) influenced by ethyl formate. Varimax rotation of the principal components showed that the cationic surfactant (benzalkonium chloride) had significantly decreased surface tension compared with the nonionic surfactant (Triton-X). Although ethyl formate was introduced as an odor modifier, it had a significant effect on pH decrease and the occurrence of effervescence with O 2 and hypochlorous acid release., Conclusions: The statistical results revealed that the 5.25% NaOCl irrigant solution should be modified with a mixture of 0.1% benzalkonium chloride, 1% ethyl formate, and 7% polyethylene glycol for obtaining a low pH and low surface tension., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)