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Summary. In this study the antibacterial effect of Jensen 1980), while other studies show that
irrigating infected root canals with 0.5 and 5 per irrigation with sodium hypochlorite solutions is
cent sodium hypochlorite solutions was evaluated highly effective in this respect (McComb &
clinically. The results indicated that there was no Smith 1975, McComb etal. 1976, Goldman et
difference between the antihacterial effect of these
al. 1981, 1982). The difference can most likely
two solutions. The combined use of EDTA and
5 per cent sodium hypochiorite solution was more be explained by the various amounts and con-
efficient than the use of sodium hypochiorite centrations of sodium hypochlorite that were
solutions alone. used. In the studies reporting good cleansing
An important observation was that bacteria effect concentrations of 5 per cent or higher
surviving instrumentation and irrigation rapidly were used, while a 1 per cent concentration
increased in number in the period between appoint- was used in the other studies.
ments when no intracanal medicament was used. During the instjuimentation of the root canal
a smeared iayer of mainly inorgamc matter is
formed on the canal walls. It has been con-
Introduction sidered important to prevent the formation of
Endodontic treatment includes the cleansing this layer (Goldberg & Abramovich 1977).
of pulp tissue and bacteria from infected root Sodium hypochlorite acts on organic matter
canals. This is performed mechanically by files but has very little effect on this layer (Baker
and supported by irrigation witb antibacterial et al. 1975, McComb & Smith 1975, McComb
and tissue dissoKing solutiotis. Sodium hypo- etd. 1976, Goldman rta^. 1981,1982, Bolanos
chiorite Js the most widely used component of & Jensen 1980). The smeared layer may,
these irrigating solutiotis. Sodium hypochlorite however, be removed by the chelating agent
has a good antimicrobia! effect in vitro (Shih ethylene diamine tetra-acetic acid (EDTA)
etal. 1970, Bioomfield & Miles 1979, Foleyrt and solutions containing EDTA have been
al. 1983), a good tissue dissolving capacity recommended for irrigation (McComb &
{The 1979, Hatid et al. 1978, Koskinen et al. Smith 1975, McComb et al. 1976, Goldberg
1980, Mower & Wesselink 1982) at»d a low & Abramovich 1977, Goldberg & Spielberg
irritant effect on tissues (The et al. 1980, 1982). Irrigation with both sodium hypo-
Lamersrta/. 1980). chlorite and EDTA solutions has been reaim-
mended to remove the smeared layer and
The cleansing effect of irrigation with
organic matter in the canal (Goldman et al.
sodium hypochlorite solution has recently
1982).
been studied by scannitig electron microscopy.
Some of these studies indicate that irrigation The scanning electron microscopic studies
with sodium hypochlorite solutions does not have, however, given very sparse infonnation
dean oi^anic matter and debris from the canal concerning the antibacterial efficiency of irri-
efficiently (Baker et al. 1975, Bolanos & gation with these solutions. In the present
study the clinical efficiency of sodium hypo-
chlorite and EDTA as components of irrigating
Correspondence: A. Bystrfim, Department of
Endodontics, University of Umei, S-901 87 Umea, solutions was evaluated by bacteriological
Sweden. methods.
35
36 A. BystrUm IS G. Sundqvist
Tabte I. Bacterial strains persisting at the third appointment in eight root canals treated with
0.5 per cent NaOQ, six treated with 5 per cent NaOQ and three root canals treated with 5
per cent NaOQ and EDTA
Streptocoeem miileri
Streptococcus mutans
Streptococcus sanguis
Streptococcus intermedius
Streptococcus morkllorum
Peptostreptococcus aaaerohius
Peptostreptococcus micros
Arachnia propionica
Euhacterium alactotyticum
Eubacterium brachy
Eubacterium lentum
Euhacterium timidum
Lactohacillus sp.'
Lactobacillus sp. group 1>
Fusohacterium sp.
Pusobacterium nucleatum
Bacteroides sp.
Bacteroides gingivalis
Bacteroides intermedius
Bacteroides oralis
Capnocytopkaga ochracea
Wolmdla recta
'These anaerobic strains do not fit into recognized species. Group 1 corresponds to strains
classified by numerical taxonomy (Sundqvist 1976).
however, that in spite of frequent application 1977, Rubin « al 1979). This layer may con-
5 per cent sodium hypochiorite solution did tain bacteria and also prevent the penetration
not exterminate ail bacteria frotn mfected root of the antibacterial solutions into infected
canals. The sodium hypochloHte solution may dentinal tubules (Chimside 1958, Shovelton
not have penetrated Into confined areas of the 1964). By including EDTA in the irrigating
root canal (Senia rtai 1971, Bakerrta/. 1975, solution the formaticm of the smeared layer
McComb et al. 1976, Rosenfeld et al, 1978, may be prevented but the clinical significance
Rubin <?fl/. 1979). of this has not been proved (McComb et al.
When the cleaning and debriding properties 1976, Goldman rtai 1981,1982, Goldberg &
of irrigating solutions have been evaluated Abramowich 1977, Bolanos &Jettsen, 1980).
in scanning electron microscopy it has been The present study indicated that the combined
found that instrumentation produced a smeared use of EDTA and 5 per cent sodium hypo-
layer on the dentinai wails, which may com- chlodte solutions was mwe efficient than the
pletely obturate the dentinat tubules (Baker et use of sodium hypochlcnite solutions done, but
al 1975, McComb et al 1976, Lester & Boyde none the less three out of 20 erf the treated
Antibacterial action ofNaOCland EDTA 39
canals contained living bacteria at the third BYSTROM, A. & SUNDQVIST, G . (1983) Bacteriologic
appointment (Fig. 1). Recent results indicate evaluation of the effect of 0.5 per cent sodium
that decreasing the surface tension of irri- hypochlorite in endodondc therapy. Oral Surgery,
gadng solutions by adding a detergent (Abou- Oral Medicine and Oral Pathology, 55, 307-312.
Rass & Patonai 1982, Cunningham et al. CAMERON, J.A. (1983) The use of ultrasonics in the
removal of the smear layer: a scanning electron
1982a, or the use of ultrasound may improve
microscope study. Journal of Endodontics. 9,
the efficiency of treatment. The use of ultra- 289-292.
sound has been shown to improve the cleaning CHiRNsniE, l.M. (1958) The bacteridogical status of
of the canal by removing the smeared layer, dentine around infected pulp canals. A'np
and by increasing the tissue-dissolving and Zealand Dental Journal, 54, 173-183.
antimicrohial effects of sodium hypochlorite CUNNINGHAM, W.T., COLE, J . S . & BAUEKJIANT, A.Y.
(Cunningham et al 1982b, c, Cameron 1983, (1982a) Effect of alcohol on the spreading abilit)'
Moorer & Wesselink 1982). of sodium hypochlorite endodontic irrigant. Oral
An important observation in this and earlier Surgery, Oral Medicine and Oral Pathology, 54,
333-335.
studies (Bystrom & Sundqvist 1981, 1983)
CUNNINGHAM, W.T., MAIITIN, H . & FORREST, W . R .
was that bacteria surviving instrumentadon
(1982b) Evaluation of root canal debridement by
and irrigation rapidly increased in number in the endosonic ultrasonic synergistic system. Oral
the empty root canals in the pyeriod between Surgery, Oral Maiicinr and Oral Pathology, S3,
appointments. Similar results have been 401W4
obtained in other studies in which no intra- CUNNINGHAM, W T . , MARTIN, H . , PELLEU, G . B . &
canal medicament was used between appoint- STOOPS, D . E . (1982C) A comparison of anti-
ments (Stewart rta/. 1969, Bence etal. 1973). microbial effectiveness of endosonic and hand
Therefore, the efficiency of antimicrobial root cana! therapy. Oral Surgery. Oral Medicine
agents as inter-treatment dressings should be and Oral Pathology. 54, 238-241.
evaluated. CVEK, M . , NOIID, C - E . & HOLLENDER, L . (1976)
Antimicrobial effect of root canai debridement in
teeth with immature root. A clinical and micro-
bioiogic study. Odontoiogisk Revy, 27, 1—10.
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