Title

Comparison of Antibacterial and Toxic Effects of Clorhexidine and Sodium Hypochlorite Root Canal Irrigants in Primary Teeth

Clinical Question

In a patient with primary dentition, does irrigating the root canal system with concentrated chlorhexidine provide better anti-microbial activity than irrigating with sodium hypochlorite?

Clinical Bottom Line

Irrigating canals of primary teeth with chlorhexidine shows substantially better microbial inhibition and is more biocompatable than NaOCl; low level of evidence. (See Comments on the CAT below)

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
12801290	Oncag/2003	60 freshly extracted intact, permanent teeth	Laboratory Study
Key results	The study demonstrated that Chlorhexidine (in the form of 2% chlorhexidine gluconate and Cetrexidin) was significantly more effective on E. faecalis than the 5.25% NaOCl (P < 0.05).
12801290	Oncaq/2003	91 root canals (deciduous teeth) in 46 child patients 4-10yrs old	Uncontrolled Clinical Study
Key results	The results if this in vivo study gave evidence that chlorhexidine significantly impeded the growth of anaerobic bacteria than NaOCl at 48 h (P < 0.05).
12801290	Oncaq/2003	Fifteen Swiss albino	Laboratory Study
Key results	After 2 weeks NaOCl was demonstrated to be more toxic to the body than the other irrigants tested (P < 0.05).

Evidence Search

pulpectomy and deciduous teeth

Comments on
The Evidence

The laboratory studies and the cohort study started with similar groups and treated them the same. These are low level evidence. The completion rates were all greater than 80%. The follow-up and compliance were adequate for all studies. There were no competing interests.

Applicability

The subjects in the in vivo study were most representative of the target population, and the treatment would be feasible in a pediatric setting. Chlorhexidine is a more biocompatible substance than sodium hypochlorite which is a benefit to the patient, especially in cases in which the root apices are open.

Specialty

(Endodontics) (General Dentistry) (Pediatric Dentistry)

Keywords

Pulpectomy, deciduous teeth, chlorhexidine, sodium hypochlorite

ID#

811

Date of submission

05/05/2011

E-mail

goodwink@livemail.uthscsa.edu

Author

Kathleen Goodwin

Co-author(s)

Co-author(s) e-mail

Faculty mentor

Maria Mendez Cervantes, DDS

Faculty mentor e-mail

CervantesMen@uthscsa.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?)

None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

by Salim Aqil (San Antonio, TX) on 10/08/2014
A PubMed search on irrigants used during a Non-surgical root canal treatment of mature permanent teeth was performed October 2014. A recent publication was found: Fedorowicz Z 2012, PubMed: 22972129. This RCT compared effectiveness of Sodium hypochlorite and chlorhexidine in de-naturing bacteria in a root canal system and found insufficient evidence that one irrigant is superior to another in de-activating bacteria.