Evaluation of antimicrobial efficacy of an herbal preparation vs triple antibiotic paste against E. faecalis: an in vitro study
DOI:
https://doi.org/10.18203/2349-3291.ijcp20260407Keywords:
Herbal preparation, Triple antibiotic paste, Enterococcus faecalis, Antibacterial activity, Pediatric dentistryAbstract
Background: Enterococcus faecalis is a major pathogen responsible for persistent endodontic infections and root canal treatment failure due to its resistance and ability to survive harsh intracanal conditions. Triple antibiotic paste (TAP) is widely used for canal disinfection, but concerns related to antibiotic resistance, tooth discoloration, and cytotoxicity have led to interest in herbal alternatives. This study evaluated the antimicrobial efficacy of a herbal formulation containing Turmeric, Arjuna bark and Clove oil, against E. faecalis and compared it with TAP.
Methods: An in vitro well diffusion assay was performed using E. faecalis (ATCC 29212) inoculated on Mueller–Hinton agar. Three concentrations (20 mg/ml, 50 mg/ml, and 100 mg/ml) of the herbal extract were tested, and zones of inhibition (ZOI) were measured after incubation at 37°C for 48 hours. Minimum inhibitory concentration (MIC) was determined using a microbroth dilution method. TAP served as the positive control.
Results: The herbal preparation demonstrated measurable antimicrobial activity, showing a ZOI of 8 mm (20 mg/ml), 10 mm (50 mg/ml), and 15 mm (100 mg/ml). The MIC value for the herbal formulation was 7.81 µg/ml. TAP showed higher inhibition zones at all tested concentrations.
Conclusions: The herbal formulation exhibited significant antibacterial activity against E. faecalis, indicating its potential as a biocompatible intracanal medicament. Although TAP remained more effective at lower concentrations, the herbal preparation offers advantages such as reduced risk of antibiotic resistance and tooth discoloration. Further cytotoxicity testing and clinical studies are required to validate its clinical applicability.
Metrics
References
Hargreaves KM, Berman LH, Rotstein I, Cohen S. Cohen’s pathways of the pulp. St. Louis, MO: Elsevier. 2021: 184-258.
Ingle JI, Bakland LK, Baumgartner JC. Ingle’s Endodontics. 6th ed. Hamilton (ON): BC Decker Inc. 2008.
Siqueira JF Jr, Rôças IN. Present status and future directions: Microbiology of endodontic infections. Int Endod J. 2022;55(3):512-30. DOI: https://doi.org/10.1111/iej.13677
Sharma J, Jhamb S, Mehta M, Bhushan J, Bhardwaj SB, Kaur A. Characterization of Enterococcus faecalis associated with root canal failures: virulence and resistance profile. J Conserv Dent Endod. 2025;28(7):602–6. DOI: https://doi.org/10.4103/JCDE.JCDE_190_25
Mohammadi Z, Jafarzadeh H, Shalavi S, Yaripour S, Sharifi F, Kinoshita JI. A Review on Triple Antibiotic Paste as a Suitable Material Used in Regenerative Endodontics. Iran Endod J. 2018;13(1):1-6.
Parhizkar A, Nojehdehian H, Asgary S. Triple antibiotic paste: momentous roles and applications in endodontics: a review. Restor Dent Endod. 2018;43(3):28. DOI: https://doi.org/10.5395/rde.2018.43.e28
Sharma J, Jhamb S, Mehta M, Bhushan J, Bhardwaj SB, Kaur A. Prevalence of Enterococcus faecalis in refractory endodontic infections: A microbiological study. J Conserv Dent Endod. 2025;28(5):462-7. DOI: https://doi.org/10.4103/JCDE.JCDE_871_24
Evans M, Davies JK, Sundqvist G, Figdor D. Mechanisms involved in the resistance of Enterococcus faecalis to calcium hydroxide. Int Endod J. 2002;35(3):221–8. DOI: https://doi.org/10.1046/j.1365-2591.2002.00504.x
Love RM. Enterococcus faecalis--a mechanism for its role in endodontic failure. Int Endod J. 2001;34(5):399-405. DOI: https://doi.org/10.1046/j.1365-2591.2001.00437.x
Karczewski A, Feitosa SA, Hamer EI, Pankajakshan D, Gregory RL, Spolnik KJ, Bottino MC. Clindamycin-modified triple antibiotic nanofibers: a stain-free antimicrobial intracanal drug delivery system. J Endod. 2018;44(1):155-62. DOI: https://doi.org/10.1016/j.joen.2017.08.024
Prabhakar A, Taur S, Hadakar S, Sugandhan S. Comparison of antibacterial efficacy of calcium hydroxide paste, 2% chlorhexidine gel and turmeric extract as an intracanal medicament and their effect on microhardness of root dentin: an in vitro study. Int J Clin Pediatr Dent. 2013;6(3):171-7. DOI: https://doi.org/10.5005/jp-journals-10005-1213
Valera MC, Maekawa LE, de Oliveira LD, Jorge AO, Shygei É, Carvalho CA. In vitro antimicrobial activity of auxiliary chemical substances and natural extracts on Candida albicans and Enterococcus faecalis in root canals. J Appl Oral Sci. 2013;21(2):118-23. DOI: https://doi.org/10.1590/1678-7757201302135
Kalaiselvam R, Soundararajan K, Rajan RM, Deivanayagam K, Arumugam C, Ganesh A. comparative evaluation of the anti-bacterial efficacy of herbal medicaments and synthetic medicaments against E. faecalis using Real-time Polymerase Chain Reaction. Cureus. 2019;11(7):5228. DOI: https://doi.org/10.7759/cureus.5228
Setty JV, Srinivasan I, Sathiesh RT, Kale M, Shetty VV, Venkatesh S. In vitro evaluation of antimicrobial effect of Myristica fragrans on common endodontic pathogens. J Indian Soc Pedod Prev Dent. 2020;38(2):145-51. DOI: https://doi.org/10.4103/JISPPD.JISPPD_214_20
Golla S, Gambhir N, Gupta N, Singh R, Singh D. A Comparative Evaluation of Herbal Extracts and Triple Antibiotic Paste as Intracanal Medicament against Enterococcus faecalis: A Microbiological Study. Int J Clin Pediatr Dent. 2024;17(3):285-90. DOI: https://doi.org/10.5005/jp-journals-10005-2791
Mahendra J. Antimicrobial and anti-inflammatory activity of Terminalia arjuna. Bioinformation. 2023;19(2):184-9. DOI: https://doi.org/10.6026/97320630019184