Abstract
Background and objectives: This study aimed to evaluate the synergistic antimicrobial activity of extracts obtained from Salvadora persica (Miswak), Commiphora molmol (myrrh) and Azadirachta indica (neem) in combination with commercially available antimicrobial agents: penicillin, tetracycline, ofloxacin and fluconazole on endodontic pathogens such as Enterococcus faecalis, Streptococcus mitis, Actinomyces naeslundii and Candida albicans. Materials and Methods: Microbiological samples from the root canals of the teeth undergoing retreatment were taken using sterile paper points kept at full length in the canal for 30 s. The disc diffusion method was used to check the susceptibility of microbes to the plant extracts and antimicrobials by measuring the diameter of the inhibition zones. Against the microbes, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC)/minimum fungicidal concentration (MFC) of the plant extracts were assessed. The fractional inhibitory concentration index (FICI) was used to estimate the synergistic effect of plant extracts combined with antimicrobials against the resistant endodontic microbes. Results: The findings clearly indicate the effectiveness of all the three plant extracts, Commiphora molmol, Azadirachta indica, Salvadora persica, against all the experimental pathogenic microorganisms except for the ineffectiveness of Azadirachta indica, Salvadora persica against Candida albicans. Maximum antimicrobial activity was displayed by Azadirachta indica against Enterococcus faecalis (MIC = 0.09 ± 1.2 mg/mL, MBC = 0.78 ± 1.25 mg/mL) and the minimum antimicrobial activity was displayed by Commiphora molmol against Actinomyces naeslundii (MIC = 12.5 ± 3.25 mg/mL, MBC = 100 ± 3.75 mg/mL). The best synergy was displayed by Commiphora molmol with fluconazole against Candida albicans (FICI = 0.45). Conclusions: The current study delineates the variable antimicrobial activity of plant extracts against the experimental endodontic pathogenic microorganisms. Plant extracts in conjunction with various antimicrobials can be valuable aids in combating relatively resistant endodontic microorganisms that have been the cause of worry in recent years, leading to failure even in treatment procedures following all required protocols.
Highlights
Enterococci are the most common bacteria found in the oral cavity, gastrointestinal tract, and vagina of humans and animals
This study was aimed to evaluate the synergistic antimicrobial activity of extracts obtained from S. persica, C. molmol and A. indica combined with commercially available antimicrobial agents: penicillin, tetracycline, ofloxacin and fluconazole on endodontic pathogens, such as E. faecalis, S. mitis, A. naeslundii and C. albicans
Plant extracts in conjunction with various antimicrobial agents can be a valuable aid in combating the relatively resistant endodontic microorganisms that have been the cause of worry in recent years leading to failure even in the treatment procedures following all the required protocols
Summary
Enterococci are the most common bacteria found in the oral cavity, gastrointestinal tract, and vagina of humans and animals. Enterococci are Gram-positive cocci that can occur singly, in pairs, or as short chains. They are facultative anaerobes, possessing the ability to grow in the presence or absence of oxygen. Enterococcus species, especially Enterococcus faecalis (E. faecalis), are associated with chronic periodontitis and failed root canal treatments involving chronic apical periodontitis [2,3]. The principal cause for E. faecalis to be associated with endodontic failure is its ability to invade dentinal tubules and strong adhesion to collagen [7], which is abundantly present in root dentin and cementum. A confocal laser-scanning microscope showed that the depth of viable E. faecalis ranges from 100 to 400 μm into dentinal tubules
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