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Title Chlorhexidine Is Not Superior To Sodium Hypochlorite As A Root Canal Disinfectant During Root Canal Therapy For Apical Periodontitis
Clinical Question In a patient who is diabetic, does irrigating with chlorhexidine in addition to sodium hypochlorite improve the healing rate of apical periodontitis better than sodium hypochlorite alone?
Clinical Bottom Line Chlorhexidine is apparently neither inferior nor superior to sodium hypochlorite as a root canal disinfectant. Patients in this study were recruited from a dental school endodontic clinic and were not stated do be diabetic. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21238793Rocas/2011Patients with non-contributory med history and single rooted single canaled teethCohort Study
Key resultsNo significant difference between sodium hypochlorite and CHX for incidence of negative polymerase chain reaction after chemomechanical preparation of the canals.
Evidence Search Sodium Hypochlorite"[Mesh] AND "Chlorhexidine"[Mesh]
Comments on
The Evidence
20 patients were treated with 0.12% chlorhexidine irrigation and 30 patients were treated with 2.5% sodium hypochlorite irrigation.
Applicability Patients in this study had non-contributory medical histories, single rooted single canal teeth. No other patient information was given. The inclusion criteria for the teeth were; intact chamber walls, necrotic pulp, radiographic evidence of apical periodontitis.
Specialty/Discipline (Endodontics)
Keywords chlorhexidine, sodium hypochlorite, apical periodontitis
ID# 2087
Date of submission: 09/15/2011spacer
E-mail berkhoff@livemail.uthscsa.edu
Author Julie Berkhoff
Co-author(s) e-mail
Faculty mentor/Co-author Fabricio Teixeira, DDS, MS, PhD
Faculty mentor/Co-author e-mail fabricio-teixeira@uiowa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Sara Fayazi (San Antonio, TX) on 09/13/2013
I conducted the search in PubMed and found one review article relevant by Luddin & Ahmed, 2013, PMID: 23349569 . Enterococcus faecalis is one of the most resistant microorganisms that dominants the microbial ecosystem of persistent periradicular lesions. For that reason, many in vitro and in vivo studies evaluated and compared the antibacterial activity of sodium hypochlorite and chlorhexidine at varying concentrations using different experimental models against this microorganism. This study analyzed the related laboratory investigations of both irrigants against E.faecalis by agar diffusion model. By using the same method, some studies demonstrated that NaOCl at the concentrations of 2.5% and below has lower antibacterial activity than 2% CHX against E. faecalis. However, few authors claimed that the efficacy of 2.5% NaOCl was equivalent to that of 0.2% CHX. It seems that using both irrigants has synergistic effect, so the combination of both of them mostly recommended.
by Jongsung Kim (San Antonio, TX) on 07/13/2012
Previous comment was based on the same article. No new evidence has been published. From the article, the most prevalent taxa in S2 samples from the NaOCl group were Propionibacterium acnes, Streptococcus species, Porphyromonas endodontalis, and Selenomonas sputigena. In the CHX group, the most prevalent taxa in S2 were Dialister invisus, Actinomyces israelii, Prevotella baroniae, Propionibacterium acidifaciens, and Streptococcus species. Therefore, if chlorhexidine and sodium hypochlorite are utilized in the same appointment, not mixed or used simultaneously, the reduction of bacteria is greater than using each one alone. The CAT is up to date.
by Jongsung Kim (San Antonio, TX) on 07/09/2012
Chlorhexidine and sodium hypochlorite work on different stains of bacteria. Although chlorhexidine is not superior to sodium hypochlorite, using them together would bring synergetic effect on eliminating bacteria.

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