Effectiveness of Intracanal Irrigants and Medications against the Yeast Candida albicans

doi:10.1097/00004770-200202000-00004

Journal of Endodontics

Volume 28, Issue 2, February 2002, Pages 68-71

https://doi.org/10.1097/00004770-200202000-00004 Get rights and content

An in vitro study was conducted to determine the susceptibility of the yeast Candida albicans to various intracanal irrigants and medications. The minimum inhibitory concentration (MIC) of sodium hypochlorite, hydrogen peroxide, chlorhexidine digluconate, and aqueous calcium hydroxide that is required to kill a standardized inoculum of C. albicans was determined. Growth of the yeast was measured by optical density. Sodium hypochlorite, hydrogen peroxide, and chlorhexidine digluconate were effective anticandidal agents with MICs of <10 μg/ml, 234 μg/ml, and <0.63 μg/ml, respectively. Aqueous calcium hydroxide had no activity. A standardized inoculum of C. albicans cells was also placed in direct contact with either calcium hydroxide paste or camphorated para-monochlorophenol (CPMC), and candidal growth was assessed by colony counts on Sabouraud’s dextrose agar. Calcium hydroxide paste and CPMC, when maintained in direct contact with C. albicans, were effective antifungal agents.

Section snippets

Experimental Design

A dilution technique was used to expose a standardized inoculum of C. albicans to various concentrations of water-soluble medications. The medications tested were sodium hypochlorite (NaOCl), hydrogen peroxide (H₂O₂), calcium hydroxide (Ca(OH)₂), and chlorhexidine digluconate. Negative controls, consisting of culture media with no test material added, were used to ensure that the yeast was viable in each experiment. Amphotericin B was used as a positive control to ensure that the yeast was

Controls

All negative controls, i.e. culture tubes in which no medication was placed, were positive for C. albicans growth. The mean OD₅₃₀ ± SE for negative controls using RPMI growth medium was 0.640 ± 0.058. Chlorhexidine digluconate precipitated in RPMI; using half-strength RPMI to test the medication obviated this problem. The mean OD₅₃₀ ± SE for negative controls using half-strength RPMI was 0.391 ± 0.015.

The mean OD₅₃₀ of C. albicans growing in the positive, amphotericin B, controls was observed.

DISCUSSION

This in vitro study examined commonly used intracanal medications and irrigants and determined the MIC of each that is required to kill a standardized population of C. albicans. All negative controls were positive for fungal growth, indicating that the experimental protocol did allow for the growth of C. albicans. The positive controls showed complete inhibition of C. albicans at concentrations of 0.250 μg amphotericin B/ml and stronger. These results agree with published ranges of MICs for

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Fresh colony of C. albicans grown on the SDA agar was suspended in 0.9% (w/v) saline solution. Optical density of the C. albicans was adjusted spectrophotometrically at 530 nm (OD530) to approximately 0.087; OD530 of 0.080 corresponding to 1 × 106 CFU/ml (Ferguson et al., 2002; Takahashi et al., 2013). The C. albicans (1 × 106 CFU/ml) suspension was cultured on the SDA plate.
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All medicaments showed significantly lower CFU than saline (P < .05), and their antifungal efficacies were similar at both 200- and 400-μm tubular depths (P > .05). HBD3-C15 had similar antifungal efficacy to that of CHX at both depths (P > .05), and both medicaments had significantly lower CFU than CH at both depths (P < .05).
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La flore endodontique est dominée dans la partie apicale des canaux par des bactéries anaérobies strictes et quelques anaérobies facultatives mais aussi par les levures du genre Candida et particulièrement l’espèce Candida albicans qui sont impliquées dans l’entretien et la persistance des infections endodontiques. Leur élimination du système canalaire en pratique par des procédés chémo-mécaniques de désinfection n’est pas toujours garantie. C’est ainsi que cette étude in vitro a été réalisée pour déterminer la sensibilité de C. albicans à l’hypochlorite de sodium (NaOCl) dosée à 2,5 %, au digluconate de chlorhexidine à 0,5 % et à l’hydroxyde de calcium utilisée en médication interséance.
La méthode de diffusion a été utilisée dans un premier temps pour tester la sensibilité des souches de C. albicans aux produits précités. Puis une technique de dilution nous a permis de déterminer la concentration minimale inhibitrice des produits actifs sur C. albicans.
Des souches de C. albicans provenant des dents à pulpe infectée de patients ont montré une sensibilité à l’hypochlorite de sodium pour une concentration minimale inhibitrice inférieure à 70 μg/mL et de 60 μg/mL pour la chlorhexidine.
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Endodontic flora is dominated in the apical part of the channels by strict anaerobic and some facultative anaerobic bacteria but also by Candida yeasts, especially Candida albicans species that are involved in the maintenance and persistence of endodontic infections. Their elimination of the canal system in practice by chemo-mechanical methods of disinfection is not always guaranteed. Thus, this in vitro study was performed to determine the sensitivity of C. albicans with sodium hypochlorite (NaOCl) dosed at 2.5 %, the chlorhexidine digluconate 0.5 % and calcium hydroxide used in inter-session medication.
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Les infections endodontiques sont caractérisées par leur polymorphisme microbien avec la présence d’agents pathogènes bactériens. Le but de cette étude était de rechercher la présence des levures dans les canaux des dents nécrosées avec ou sans image péri-apicale et d’étudier la sensibilité de celles-ci à une désinfection à l’hypochlorite de sodium à 2,5 %.
Des prélèvements endocanalaires réalisés à l’aide de pointes en papier avant et après désinfection à l’hypochlorite de sodium dosée à 2,5 % sur 50 dents monoradiculées chez 38 patients. Ces prélèvements ont été ensemencés dans des boîtes de Pétri contenant du Sabouraud-chloramphénicol (SC). Elles étaient ensuite incubées dans une étuve à 37 °C pendant 48 h. La présence de levures était attestée par des colonies blanchâtres sur tout le pourtour de la pointe en papier et de blastospores à l’examen microscopique dans de l’eau physiologique entre lame et lamelle. L’identification de l’espèce se basait sur ces examens macroscopiques et microscopiques associés au test de blastèse.
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: This research was supported by a grant from the Southern Illinois University School of Dental Medicine Research Committee.

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SCIENTIFIC ARTICLESEffectiveness of Intracanal Irrigants and Medications against the Yeast Candida albicans

Section snippets

Experimental Design

Controls

DISCUSSION

J Endodon

Arch Oral Biol

J Endodon

J Endodon

J Endodon

J Endodon

Light and electron microscopic studies of root canal flora and periapical lesions

J Endodon

SCIENTIFIC ARTICLES
Effectiveness of Intracanal Irrigants and Medications against the Yeast Candida albicans