Effect of a Benzalkonium Chloride Surfactant–Sodium Hypochlorite Combination on Elimination of Enterococcus faecalis

• NaOCl and surfactant combination on removal of a biofilm of E. faecalis was studied.
• Standard needle irrigation was used in 64 human single canal anterior teeth.
• 0.008% BAK+6% NaOCl significantly improves clearance of heavily infected straight canals.
• No added benefit was seen when adding the BAK to enhance dentinal tubular penetration.

IntroductionThe purpose of this investigation was to determine the effect of a sodium hypochlorite–surfactant combination on the removal of Enterococcus faecalis from infected teeth.MethodsSixty-four extracted human single canal anterior teeth were prepared with rotary instrumentation and sterilized. Teeth were divided into 4 groups, N = 16. Three experimental groups were inoculated with E. faecalis and cultured for 21 days before use: positive control group, no irrigation; NaOCl group, irrigated with 5 mL 6% NaOCl; and NaOCl/BAK group, irrigated with 5 mL 6% NaOCl/0.008% benzalkonium chloride (BAK). The negative control group received medium only and no inoculate. Paper point sampling of the canals was obtained before irrigation (S1) for all 4 groups and for 2 groups after irrigation (S2) to determine remaining colony-forming units. After sampling, all teeth were split in half and evaluated for bacterial viability colony-forming units and penetration of dentinal tubules by using fluorescent vital dye staining and confocal laser scanning microscopy.ResultsComparison of pre-irrigation and post-irrigation paper point samples from the 2 irrigated groups showed a significant reduction in bacterial canal load (P < .001, Kruskal-Wallis), with a significantly lower load in the NaOCl/BAK group than in the NaOCl group (P = .001, Mann-Whitney U test); 68.8% of the NaOCl/BAK samples gave no recoverable counts. In contrast, no significant difference between these groups was found for counts recovered from dentin. Confocal laser scanning microscopy showed no differences in tubule penetration.ConclusionsThe addition of BAK to NaOCl significantly reduced the number of remaining bacteria within the canal after irrigation compared with NaOCl alone.