A recent Cochrane Review,1 examining the antiseptic and antibacterial irrigating solutions used to prevent infection during root canal treatment, has found a lack of evidence to strongly support one type of irrigating solution over another.
Although bacterial cultures appeared to be effectively reduced when chlorhexidine was compared to saline, or a higher concentration of sodium hypochlorite (5%) was compared to a lower concentration (1%), most of the studies did not report clinically important and patient-relevant differences.
Eleven trials were included in the review, involving a total of 851 participants with 879 teeth that had undergone root canal treatment involving the use of irrigants. These trials evaluated a range of irrigating regimes, including various strengths, combinations and methods, and duration of administration. Sodium hypochlorite was the most commonly used irrigating solution in the included trials. Adverse effects were not reported in any of the studies.
“Our review found that the current research on the use and effectiveness of irrigants and supporting antimicrobials/bacterials is focused on their effectiveness in reducing bacterial counts,” says Dr. Mona Nasser, one of the review’s authors. “More studies are required with a particular focus on the outcomes that are important for clinicians and their patients,” she says.
“At the moment, none of the studies show a substantive difference in the effectiveness of sodium hypochlorite and chlorhexidine. This raises the question of whether the additional costs of chlorhexidine or other expensive irrigants is justifiable,” adds Dr. Nasser.
Based on the results of the systematic review, the authors recommend that clinicians consider both the benefits and potential harms when selecting an irrigant for non-surgical root canal treatment.
- Fedorowicz Z, Nasser M, Sequeira-Byron P, de Souza RF, Carter B, Heft M. Irrigants for non-surgical root canal treatment in mature permanent teeth (Review). The Cochrane Library. 2012; Issue 9.