 Abstract | | |
Irrigating solutions are an essential adjunct in the root canal therapy for the complete disinfection of the root canal space. The recent trend focuses on the use of herbal extracts in endodontics owing to their advantages and minimal side effects. In view of this, we have proposed a classification system to classify herbal endodontic irrigants as currently, there is no standard classification available. This structured classification will give an overview of the diversity of herbal irrigants and also highlight the potential use of each of them. Thus, it will be easy to segregate the study and use the herbal endodontic irrigants according to the requirements. The proposed classification system shall prove to be highly beneficial to the students, researchers, and clinicians.
Keywords: Antimicrobial property; chelating ability; classification; herbal endodontic irrigants; pulp tissue dissolution ability
How to cite this article:
Kale PP, Raut AW. A proposed classification system for herbal endodontic irrigants. J Conserv Dent 2021;24:293-5 |
| Introduction | |  |
The success of endodontic therapy is multifactorial, starting from the preparation of access cavity, biomechanical preparation followed by three-dimensional obturation of the root canal system. The intricacies of the root canal have been found to accommodate persistent biofilms in teeth. Thus, the primary goal of endodontic treatment must be to accomplish root canal disinfection, thus preventing re-infection. The use of chemical substances along with mechanical instrumentation as an aid for the disinfection and removal of necrotic tissue from the root canal space has been a constitutive part of endodontic therapy.
An ideal endodontic irrigant should possess the ability to dissolve pulp tissue, collagen, remove biofilm, and to remove the smear layer. It should be nontoxic or carcinogenic to the peripheral tissue cells of the tooth, show no deleterious effect on the sealing abilities of sealers, exhibit no irritation to the periapical tissues and should be easily available.
Sodium hypochlorite has been the most extensively used root canal irrigant due to its exemplary properties. However, it is associated with several undesirable characteristics such as allergic potential, tissue toxicity, risk of emphysema when extruded, disagreeable smell/taste, and inability to remove the smear layer. Other irrigants commonly used in endodontics such as chlorhexidine, ethylene-diamine-tetra-acetic acid, citric acid, etc., are also associated with side effects such as tooth discoloration and reduction in the microhardness of root dentin.
India is famous for its rich heritage of traditional medicinal systems. With herbal remedies and holistic medicine gaining increasing popularity among the public, over the past decade, there has been a paradigm shift toward the usage of phytochemicals in the field of Endodontics. Herbal endodontic irrigants have advantages such as high antimicrobial activity, anti-inflammatory, antiseptic and anti-oxidant properties, biocompatibility, ease of availability, cost effectivity, less toxicity, less or no staining of teeth such as in cases of synthetic irrigating solutions and decreased microbial resistance against Enterococcus faecalis.
| Need for Classification | | |
Extensive research has been carried out exploring the diversity of herbs to be used as endodontic irrigants. However, to the best of authors' knowledge, there is no specific classification allocating them into different groups. A systematic classification will be helpful for the students to comprehend and remember the properties of herbal irrigants. It can give a detailed overview of the diversity of herbal endodontic irrigants and can also help to understand the properties, similarities, and dissimilarities between the different irrigants. It will help the researchers to select the herbal irrigants for undertaking a study. This classification will also prove beneficial to the clinicians or practitioners as they can easily segregate specific irrigants depending on their need in the clinical practice.
Basis of classification
The most important properties an ideal root canal irrigant should possess include antimicrobial property, chelating ability, and ability to dissolve the pulp tissue. Various studies have shown that herbal irrigants may possess one or more of these properties. In the proposed classification system, the herbal irrigants have been classified based on these properties [Figure 1]. The proposed classification system has been registered by the Copyright Office of India (Registration Number: L-101236/2021).
Proposed classification
Herbal root canal irrigants with antimicrobial property
These extracts have demonstrated antimicrobial property against common endodontic pathogens.
For example, neem leaf extract (Azadirachta indica), Triphala, Propolis, Morinda citrifolia, Aloe vera, Garlic (Allium sativum), Ginger (Zingiber officianale), Green tea, Tea tree oil (Melaleuca alternifolia), Carvacrol, Turmeric (Curcuma longa), Arctium lappa, Babool (Acacia nilotica), Tulsi (Ocimum sanctum), Cinnamon (Cinnamomum zeylanicum), Miswak (Salvadora persica), Passion fruit juice, Jeeryin, Clove (Syzigium aromaticum), Hybanthus enneaspermus, Guava (Psidium guajava), Terminalia chebula seed extract, Mangifera indica L. kernel (Mango kernel), Zataria multiflora Essential oil, Andrographis paniculata, Thymus vulgaris, Calendula arvensis, Mimusops elengi, Syzygium cumini.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10]
Herbal root canal irrigants with chelating ability
These extracts possess the ability to remove the smear layer formed on the dentin surface after instrumentation.
For example, neem leaf extract (A. indica), triphala extract, M. citrifolia, garlic (A. sativum), green tea, tea tree oil (M. alternifolia), Tulsi leaf extract (O. sanctum), Miswak (S. persica), Grapefruit (Citrus paradisi), passion fruit juice, orange oil, German chamomile (Marticaria recutita), T. chebula seed extract, Amla (Emblica officinalis), Pomegranate peel (Punica granatum), Citrus aurantifolia-Sapindus mukorossi extracts, Moringa oleifera, Lemon grass, Turmeric (C. longa).[11],[12],[13],[14],[15],[16]
Herbal root canal irrigants with both antimicrobial property and chelating ability
These extracts have demonstrated antimicrobial property as well as the ability to remove the smear layer.
For example, neem leaf extract (A. indica), Triphala, M. citrifolia, garlic (A. sativum), green tea, tea tree oil (M. alternifolia), Tulsi leaf extract (O. sanctum), Miswak (S. persica), passion fruit juice, T. chebula seed extract, and turmeric (C. longa).[17],[18]
Herbal root canal irrigants with pulp tissue dissolution ability
These extracts possess the ability to dissolve the pulp tissue.
For example, S. mukorossi extract, Garlic (A. sativum), Nepenthes khasiana digestive fluid.[19],[20],[21]
| Outcome of Classification | | |
The proposed classification delineates the diverse herbal endodontic irrigants and shall prove to be extremely beneficial for students, researchers, and clinicians.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Tewari RK, Kapoor B, Mishra SK, Kumar A. Role of herbs in endodontics. J Oral Res Rev 2016;8:95.  [Full text] |
| 2. | Sivakumar A, Ravi V, Prasad AS, Sivakumar JS. Herbendodontics–Phytotherapy in endodontics: A review. Biomed Pharmacol J 2018;11:1073-82. |
| 3. | Gupta A, Duhan J, Tewari S, Sangwan P, Yadav A, Singh G, et al. Comparative evaluation of antimicrobial efficacy of Syzygium aromaticum, Ocimum sanctum and Cinnamomum zeylanicum plant extracts against Enterococcus faecalis: A preliminary study. Int Endod J 2013;46:775-83. |
| 4. | Subbiya A, Mahalakshmi K, Pushpangadan S, Padmavathy K, Vivekanandan P, Sukumaran VG. Antibacterial efficacy of Mangifera indica L. kernel and Ocimum sanctum L. leaves against Enterococcus faecalis dentinal biofilm. J Conserv Dent 2013;16:454-7. |
| 5. | Choudhary E, Indushekar KR, Saraf BG, Sheoran N, Sardana D, Shekhar A. Exploring the role of Morinda citrifolia and Triphala juice in root canal irrigation: An ex vivo study. J Conserv Dent 2018;21:443-9. [ PUBMED] [Full text] |
| 6. | Tyagi SP, Sinha DJ, Garg P, Singh UP, Mishra CC, Nagpal R. Comparison of antimicrobial efficacy of propolis, Morinda citrifolia, Azadirachta indica (Neem) and 5% sodium hypochlorite on Candida albicans biofilm formed on tooth substrate: An in-vitro study. J Conserv Dent 2013;16:532-5. [ PUBMED] [Full text] |
| 7. | Sedigh-Shams M, Badiee P, Adl A, Sarab MD, Abbaszadegan A, Nabavizadeh M. In vitro comparison of antimicrobial effect of sodium hypochlorite solution and Zataria multiflora essential oil as irrigants in root canals contaminated with Candida albicans. J Conserv Dent 2016;19:101-5. [ PUBMED] [Full text] |
| 8. | Dedhia J, Mukharjee E, Luke AM, Mathew S, Pawar AM. Efficacy of Andrographis paniculata compared to Azadirachta indica, Curcuma longa, and sodium hypochlorite when used as root canal irrigants against Candida albicans and Staphylococcus aureus: An in vitro antimicrobial study. J Conserv Dent 2018;21:642. [ PUBMED] [Full text] |
| 9. | Gupta D, Kamat S, Hugar S, Nanjannawar G, Kulkarni R. A comparative evaluation of the antibacterial efficacy of Thymus vulgaris, Salvadora persica, Acacia nilotica, Calendula arvensis, and 5% sodium hypochlorite against Enterococcus faecalis: An in-vitro study. J Conserv Dent 2020;23:97-101. [Full text] |
| 10. | Mistry KS, Sanghvi Z, Parmar G, Shah S, Pushpalatha K. Antibacterial efficacy of Azadirachta indica, Mimusops elengi and 2% CHX on multispecies dentinal biofilm. J Conserv Dent 2015;18:461-6. [ PUBMED] [Full text] |
| 11. | Sebatni MA, Kumar AA. Smear layer removal efficacy of herbal extracts used as endodontic irrigants: An in vitro study. Endodontology 2017;29:35. [Full text] |
| 12. | Chhabra N, Gyanani H, Kamatagi L. Smear layer removal efficacy of combination of herbal extracts in two different ratios either alone or supplemented with sonic agitation: An in vitro scanning electron microscope study. J Conserv Dent 2015;18:374-8. [ PUBMED] [Full text] |
| 13. | Sadr Lahijani MS, Raoof Kateb HR, Heady R, Yazdani D. The effect of German chamomile ( Marticaria recutita L.) extract and tea tree ( Melaleuca alternifolia L.) oil used as irrigants on removal of smear layer: A scanning electron microscopy study. Int Endod J 2006;39:190-5. |
| 14. | Rao SA, Sowjanya KI, Sunitha L. Comparison of smear layer removal ability and the effect on root dentin strength of garlic extract and EDTA used as final irrigants – An in vitro study. Indian J Conserv Endod 2016;1:81-5. |
| 15. | Balto H, Ghandourah B, Al-Sulaiman H. The efficacy of Salvadora persica extract in the elimination of the intracanal smear layer: A SEM study. Saudi Dent J 2012;24:71-7. |
| 16. | Jain PA, Tejaswi S, Parinitha MS, Shetty S, Ambikathanaya UK. Comparative evaluation of antibacterial activity of Punica granatum, Acacia nilotica and Emblica officinalis against Enterococcus faecalis and their smear layer removal ability when used as endodontic irrigants: An in-vitro study. Int J Res Rev 2019;6:8. |
| 17. | Kumar A, Sheerin Sarthaj A, Maria Antony S. Comparative evaluation of antibacterial and layer removal efficacy of two different herbal irrigants – An in vitro study. Int Healthcare Res J 2018;1:350-4. |
| 18. | Subbiya A, Roopchander K, Mahalakshmi K, Padmavathy K, Vivekanandan P. Bactericidal and smear layer removal efficacy of herbal alternatives against Enterococcus faecalis dentinal biofilm - An ex-vivo Study. Pesquisa Brasileira em Odontopediatria e Clínica Integrada 2020;20:e5475. |
| 19. | Güçlüer Ö, Akarsu E, Yavuz E, Er K, Kuştarcı A. Human pulp tissue dissolution ability of different extracts of Sapindus mukorossi: An in vitro study. Chin Herbal Med 2020;12:178-82. |
| 20. | Rao SA, Sunitha L, Rao BN, Naik JP, Shekar VC. Efficacy of garlic extract and sodium hypochlorite on dental pulp dissolution: An in vitro study. Saudi Endod J 2017;7:36. [Full text] |
| 21. | Tamilselvi R, Rosaline H, Porkodi I, Veronica A, Kandaswamy D. An in vitro comparison of dissolution of human pulp in sodium hypochlorite, ethanolic extract and digestive secretion of insectivorous plants. Indian J Public Health Res Dev 2019;10:942-946. |
Correspondence Address:
Dr. Purva Pravin Kale
Anand Bhawan, Opposite Lokmat Square, Dhantoli, Nagpur - 440 012, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jcd.jcd_75_21
[Figure 1] |
