The properties and applications of chlorhexidine in endodontics

Abstract

Microorganisms and their by-products are considered to be the major cause of pulp and periradicular pathosis. Hence, a major objective in root canal treatment is to disinfect the entire root canal system, which requires that all contents of the root canal system be eliminated as possible sources of infection. This goal may be accomplished using mechanical instrumentation and chemical irrigation, in conjunction with medication of the root canal system between treatment sessions. To reduce or eliminate bacteria, various irrigation solutions have been advocated. Chlorhexidine is a cationic molecule, which can be used during treatment. It has a wide range of antimicrobial activity. Its cationic structure provides a unique property named substantivity. The purpose of this paper is to review the structure and mechanism of action of CHX, its antibacterial and antifungal activity, its effect on biofilm, its substantivity (residual antibacterial activity), its tissue solvent ability, its interaction with calcium hydroxide and sodium hypochlorite, its anticollagenolytic activity, its effect on coronal and apical leakage of bacteria, its toxicity and allergenicity and the modulating effect of dentine and root canal components on its antimicrobial activity. A Medline search was performed from 1981 to the end of March 2008 and was limited to English-language papers. The keywords searched on Medline were 'chlorhexidine AND endodontics', 'chlorhexidine AND root canal therapy', 'chlorhexidine AND substantivity' and 'chlorhexidine AND toxicity'. The reference lists of each article were manually checked for additional articles of relevance.

Influence of Endodontic Irrigants on Resin Sealer Bond Strength to Radicular Dentin

“…Accordingly, a comparative evaluation of the adhesion of Epiphany and AH Plus endodontic sealers to human root dentin treated with 1% NaOCl or 1% NaOCl+17% EDTA using the push-out test have shown that AH Plus sealer presented greater adhesion to dentin than Epiphany, regardless of the treatment of the root canal walls 7,17) . However, the bond strength of AH Plus was adversely affected by NaOCl+EDTA irrigation (G H+AH ) in our study.…”

The effect of irrigation solutions on the apical sealing ability in different root canal sealers

“…1 Studies have suggested NaOCl and chlorhexidine as irrigation solutions. [2][3][4] However, MTAD is a recently developed irrigating solution that consists of tetracycline, acetic acid and detergent. 5 It has antimicrobial effect 6 and appears to be effective for removing smear layer along the entire length of the prepared root canal.…”

Antimicrobial activity of different filling pastes for deciduous tooth treatment

“…20 This agent delivers excellent action against gram-positive and gram-negative bacteria, offers 12 weeks of dentine substantivity, and is biocompatible with the periapical tissues. 21 However, studies suggest that chlorhexidine in high concentrations, as that used in this study, poses a potential systemic risk by producing reactive oxygen species (ROS), causing oxidative damage to deoxyribonucleic acid (DNA), and the release of para-chloroaniline, a cytotoxic agent with carcinogenic potential in humans. 22,23 Although Nebacetin ® ointment and Maxitrol ® ointment are not used in dental treatment, they have already established antimicrobial power in their respective uses.…”