Abstract
The prevention and treatment of oral diseases is more difficult in diabetic patients with poorly controlled blood glucose levels. This study aims to explore an effective, low-cytotoxicity medication for root canal treatment in diabetic patients. The antibacterial effect of the combination of Triton X-100 (TX-100) and metformin (Met) on Enterococcus faecalis (E. faecalis) was evaluated by determining the minimum inhibitory concentration (MIC), minimum bactericidal concentration required to kill 99% bacteria (MBC99) and by conducting dynamic time-killing assays. While the antibiofilm activity was measured by crystal violet (CV) assay, field emission scanning electron microscope (FE-SEM), confocal laser scanning microscope (CLSM) and colony-forming unit (CFU) counting assays. The expression of relative genes was evaluated by real-time quantitative polymerase chain reaction (RT-qPCR), and the cytotoxicity of the new combination on MC3T3-E1 cell was also tested. Results showed that the antibacterial and antibiofilm activities of Met could be significantly enhanced by very low concentrations of TX-100 in both normal and high-glucose conditions, with a much lower cytotoxicity than 2% chlorhexidine (CHX). Thus, the TX-100 + Met combination may be developed as a promising and effective root canal disinfectant for patients with diabetes.
Highlights
Enterococcus faecalis (E. faecalis), a Gram-positive facultative anaerobe, has been highly detected in refractory root canal infection and reinfection of human teeth [1,2,3,4]
For the culture of E. faecalis, normal brain heart infusion (BHI) medium was used to simulate normal conditions, while BHI supplemented with glucose was used to simulate high-glucose conditions
The higher MBC99 value of Met against E. faecalis in high-glucose BHI than that in normal BHI indicated that E. faecalis in high-glucose condition may be more resistant to Met
Summary
Enterococcus faecalis (E. faecalis), a Gram-positive facultative anaerobe, has been highly detected in refractory root canal infection and reinfection of human teeth [1,2,3,4]. High blood glucose levels provide rich nutrients for bacteria to survive and proliferate in infected areas. The prevention and treatment of oral diseases in diabetic patients with poorly controlled blood glucose levels would be more difficult than in those with well-controlled blood glucose levels [12,13]. The curvatures and complex internal anatomical variations of the root canal system make it difficult for the chemomechanical preparation of root canal treatment to fully achieve the treatment goals [14]. It may be difficult for the disinfectant to reach the target lesion at a fully effective concentration, due to the narrow anatomical structure of the root. Antibiotic resistance of many pathogenic bacteria is becoming a serious
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