Skip to main content Skip to main navigation menu Skip to site footer
MedNext Journal of Medical and Health Sciences
Guideline
DOI: 10.54448/mdnt21503
Submitted: 13-11-2021
Published: 10-10-2021

Major approaches to antiseptic management for endodontic treatment in the COVID-19 pandemic: a guideline

University Center North Paulista (Unorp) - Sao Jose do Rio Preto, Sao Paulo, Brazil
University Center North Paulista (Unorp) - Sao Jose do Rio Preto, Sao Paulo, Brazil
Endodontic treatment Root canal COVID-19 SARS-CoV-2 Coinfection Antimicrobial agents

Abstract

Introduction: In the COVID-19 pandemic scenario, in addition to the pathogenesis of SARS-CoV-2, microbial coinfection increases the difficulties of diagnosis, treatment, the prognosis of COVID-19, as well as it can worsen comorbidities and affect the risk of the life of patients. COVID-19 has had a profound impact on dentistry. In addition to endodontic treatment, a management protocol was suggested. Objective: To present the importance of effectively performing endodontic asepsis in the context of the COVID-19 pandemic, to elucidate that infection by the SARS-CoV-2 virus can lead to coinfection, worsening the conditions for endodontic treatment. Methods: The research was carried out from July 2021 to August 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 70 articles were found involving the endodontic treatment and COVID-19. A total of 58 articles were evaluated in full and 39 were included and evaluated in the present study. It was found that ozone has high antimicrobial action. N-acetylcysteine (NAC) has a potent effect against endodontic biofilms. Calcium hydroxide is more effective as a root canal disinfectant in primary teeth than formocresol and camphorphenol. The association of 2% chlorhexidine followed by ozone gas for 24 seconds promoted the complete elimination of Candida albicans and Enterococcus faecalis. Low-intensity laser therapy has the property of oral sterilization, facilitating tissue healing and sterilization. Combining antimicrobial photodynamic therapy with antimicrobial irrigants may provide a synergistic effect. Conclusion: There are effective treatments for the sterilization of endodontic tissues, to avoid as much as possible the coinfection with SARS-CoV-2 and the consequent worsening of the infectious condition, highlighting calcium hydroxide, ozone therapy, and laser therapy.

Metrics

Metrics Loading ...

References

  1. Chen X, Liao B, Cheng L, Peng X, Xu X, Li Y, Hu T, Li J, Zhou X, Ren B. The microbial coinfection in COVID-19. Appl Microbiol Biotechnol. 2020 Sep;104(18):7777-7785. doi: 10.1007/s00253-020-10814-6. Epub 2020 Aug 11. PMID: 32780290; PMCID: PMC7417782.
  2. Ayub K, Alani A. Acute endodontic and dental trauma provision during the COVID-19 crisis. Br Dent J. 2020 Aug;229(3):169-175. doi: 10.1038/s41415-020-1920-0. Erratum in: Br Dent J. 2020 Oct;229(8):555. PMID: 32811936; PMCID: PMC7431740.
  3. Sabino‐Silva R, Jardim ACG, Siqueira WL (2020) Coronavirus COVID‐19 impacts to dentistry and potential salivary diagnosis. Clinical Oral Investigations 12 10.1007/s00784-020-03248-x
  4. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B (2020) Transmission routes of 2019‐nCoV and controls in dental practice. International Journal of Oral Science 12, 9–11.
  5. Prati C, Pelliccioni GA, Sambri V, Chersoni S, Gandolfi MG. COVID-19: its impact on dental schools in Italy, clinical problems in endodontic therapy and general considerations. Int Endod J. 2020 May;53(5):723-725. doi: 10.1111/iej.13291. PMID: 32277770; PMCID: PMC7262194.
  6. Donlan R.M., Costerton J.W. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002;15:167–193.
  7. Siqueira J.F., Jr., Rôças I.N., Ricucci D. Biofilms in endodontic infection. Endod Top. 2010;22:33–49.
  8. Svensäter G., Bergenholtz G. Biofilms in endodontic infections. Endod Top. 2004;9:27–36.
  9. Jhajharia K., Parolia A., Shetty K.V., Mehta L.K. Biofilm in endodontics: a review. J Int Soc Prev Community Dent. 2015;5:1–12.
  10. Lee J.K., Chang S.W., Perinpanayagam H. Antibacterial efficacy of a human β-defensin-3 peptide on multispecies biofilms. J Endod. 2013; 39:1625–1629.
  11. Byström A., Claesson R., Sundqvist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Endod Dent Traumatol. 1985; 1:170–175.
  12. Lee J.K., Park Y.J., Kum K.Y. Antimicrobial efficacy of a human β-defensin-3 peptide using an Enterococcus faecalis dentine infection model. Int Endod J. 2013;46:406–412.
  13. Portenier I., Haapasalo H., Orstavik D., Yamauchi M., Haapasalo M. Inactivation of the antibacterial activity of iodine potassium iodide and chlorhexidine digluconate against Enterococcus faecalis by dentin, dentin matrix, type-I collagen, and heat-killed microbial whole cells. J Endod. 2002;28:634–637.
  14. Chávez de Paz L.E., Bergenholtz G., Svensäter G. The effect of antimicrobials on endodontic biofilm bacteria. J Endod. 2010;36:70–77.
  15. Evans M., Davies J.K., Sundqvist G., Figdor D. Mechanisms involved in the resistance of Enterococcus faecalis to calcium hydroxide. Int Endod J. 2002;35:221–228.
  16. Gomes B.P., Souza S.F., Ferraz C.C. Effectiveness of 2% chlorhexidine gel and calcium hydroxide against Enterococcus faecalis in bovine root dentine in vitro. Int Endod J. 2003;36:267–275.
  17. Haapasalo M., Qian W., Porteiner I., Waltimo T. Effects of dentin on the antimicrobial properties of endodontic medicaments. J Endod. 2007;33:917–925.
  18. Kaplan M., Atakan I.H., Aydoğdu N. Influence of N-acetylcysteine on renal toxicity of cadmium in rats. Pediatr Nephrol. 2008;23:233–241.
  19. Moon J.H., Jang E.Y., Shim K.S., Lee J.Y. In vitro effects of N-acetyl cysteine alone and in combination with antibiotics on Prevotella intermedia. J Microbiol. 2015;53:321–329.
  20. Quah S.Y., Wu S., Lui J.N., Sum C.P., Tan K.S. N-acetylcysteine inhibits growth and eradicates biofilm of Enterococcus faecalis. J Endod. 2012;38:81–85.
  21. Choi YS, Kim C, Moon JH, Lee JY. Removal and killing of multispecies endodontic biofilms by N-acetylcysteine. Braz J Microbiol. 2018 Jan-Mar;49(1):184-188. doi: 10.1016/j.bjm.2017.04.003. Epub 2017 Sep 2. PMID: 28916389; PMCID: PMC5790572.
  22. Boch T, Tennert C, Vach K, Al-Ahmad A, Hellwig E, Polydorou O (2016) Effect of gaseous ozone on Enterococcus faecalis biofilm-an in vitro study. Clinical Oral Investigations, 20, 1733–9.
  23. Case PD, Bird PS, Kahler WA, George R, Walsh LJ (2012) Treatment of root canal biofilms of Enterococcus faecalis with ozone gas and passive ultrasound activation. Journal of Endodontics 38, 523–6.
  24. Rojas-Valencia MN (2011) Research on ozone application as disinfectant and action mechanisms on wastewater microorganisms. In: Mendez-Vilas A, ed. Science Against Microbial Pathogens: Communicating Current Research and Technological Advances. Badajoz: Formatex, pp. 263–71.
  25. Junior OO, Lages GC (2012) Ozone therapy for lumbosciatic pain. Revista Dor 13, 261–70.
  26. Hubbezoglu I, Zan R, Tunc T, Sumer Z (2014) Antibacterial efficacy of aqueous ozone in root canals infected by Enterococcus faecalis. Jundishapur Journal of Microbiology 7, e11411.
  27. Huth KC, Quirling M, Maier S, et al. (2009) Effectiveness of ozone against endodontopathogenic microorganisms in a root canal biofilm model. International Endodontic Journal, 42, 3–13.
  28. Kist S, Kollmuss M, Jung J, Schubert S, Hickel R, Huth KC (2017) Comparison of ozone gas and sodium hypochlorite/chlorhexidine two-visit disinfection protocols in treating apical periodontitis: a randomized controlled clinical trial. Clinical Oral Investigations 21, 995–1005.
  29. Kaya BU, Kececi AD, Guldas HE, et al. (2014) Efficacy of endodontic applications of ozone and low-temperature atmospheric pressure plasma on root canals infected with Enterococcus faecalis. Letters in Applied Microbiology 58, 8–15.
  30. Alamoudi N, Nadhreen A, Sabbagh H, El Meligy O, Al Tuwirqi A, Elkhodary H. Clinical and Radiographic Success of Low-Level Laser Therapy Compared with Formocresol Pulpotomy Treatment in Primary Molars. Pediatr Dent. 2020 Sep 15;42(5):359-366. PMID: 33087220.
  31. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n71
  32. H Balshem H, Grade guidelines: 3 ratng the quality of evidence. Journal of Clinical Epidemiology, Maryland Heights, 64 (4) (2011) 401-406.
  33. Higgins, S Green, Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011.
  34. Jia L, Zhang X, Shi H, Li T, Lv B, Xie M. The Clinical Effectiveness of Calcium Hydroxide in Root Canal Disinfection of Primary Teeth: A Meta-Analysis. Med Sci Monit. 2019 Apr 20;25:2908-2916. doi: 10.12659/MSM.913256. PMID: 31004424; PMCID: PMC6487674.
  35. Barakat I, ElPatal MA, Abushanan A, Abd Elrady BEA. Antibacterial Effect of Metronidazole vs Chlorhexidine Solutions in Treatment of Root Canals of Primary Anterior Teeth. J Contemp Dent Pract. 2020 Apr 1;21(4):396-399. PMID: 32584275.
  36. Madurantakam P. Is calcium hydroxide more effective than formocresol or camphor phenol as intracanal disinfectants in acute pulpitis among deciduous teeth? Evid Based Dent. 2019 Sep;20(3):86-87. doi: 10.1038/s41432-019-0044-3. PMID: 31562411.
  37. Noites R, Pina-Vaz C, Rocha R, Carvalho MF, Goncalves A, Pina-Vaz I (2014) Synergistic antimicrobial action of chlorhexidine and ozone in endodontic treatment. BioMed Research International 2014, 592423.
  38. Kaur A, Bhavikatti SK, Das SS, Khanna S, Jain M, Kaur A. Efficacy of Ozonised Water and 0.2% Chlorhexidine Gluconate in the Management of Chronic Periodontitis when Used as an Irrigant in Conjugation with Phase I Therapy. J Contemp Dent Pract. 2019 Mar 1;20(3):318-323. PMID: 31204324.
  39. Cerdeira, C. D., & Lima Brigagão, M. R., & Carli, M. L., et al. (2016). Low-level laser therapy stimulates the oxidative burst in human neutrophils and increases their fungicidal capacity. J Biophotonics, 9(11-12), 1180-1188. 10.1002/jbio.201600035.
  40. Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. UFSM. Wang, Y., & Huang, Y. Y., & Wang, Y., & Lyu, P., & Hamblin, M. R. (2016). Photobiomodulation (blue and green light) encourages osteoblastic-differentiation of human adipose-derived stem cells: role of intracellular calcium and light-gated ion channels. Sci Rep. 6, 33719. 10.1038/srep33719.
  41. Bordea IR, Hanna R, Chiniforush N, Grădinaru E, Câmpian RS, Sîrbu A, Amaroli A, Benedicenti S. Evaluation of the outcome of various laser therapy applications in root canal disinfection: A systematic review. Photodiagnosis Photodyn Ther. 2020 Mar;29:101611. doi: 10.1016/j.pdpdt.2019.101611. Epub 2019 Dec 3. PMID: 31809911.
  42. Arslan H, Köseoğlu S, Doğanay Yildiz E, Arabaci T, Savran L, Yildiz DA, Veyisoğlu G. Effect of intracanal diode laser application and low-level laser therapy on CGRP change. Braz Oral Res. 2019 Mar 18;32:e125. doi: 10.1590/1807-3107bor-2018.vol32.0125. PMID: 30892373.

How to Cite

Paula, A. C. de, & Castro, F. P. L. de. (2021). Major approaches to antiseptic management for endodontic treatment in the COVID-19 pandemic: a guideline. MedNEXT Journal of Medical and Health Sciences, 2(5). https://doi.org/10.54448/mdnt21503