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Table of Contents   
ORIGINAL RESEARCH  
Year : 2018  |  Volume : 29  |  Issue : 6  |  Page : 716-720
A survey of the knowledge, attitude, and awareness about the principal choice of intracanal medicaments among the general dental practitioners and nonendodontic specialists


Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha University, Chennai, Tamil Nadu, India

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Date of Web Publication24-Dec-2018
 

   Abstract 

Background: Removal of the microbial organisms from the root canal system is a prerequisite for the successful outcome of any root canal treatment. Use of an effective intracanal medicament will assist in the disinfection of the root canal system. Intracanal medicaments have been used to disinfect root canals between appointments and reduce interappointment pain. Materials and Methods: A questionnaire survey was conducted to evaluate the knowledge, attitude, and awareness about the principal choice of intracanal medicaments among general dental practitioners and nonendodontic specialists. The questionnaire consisted of 11 questions related to intracanal medicaments in Endodontics. It was distributed to 75 general dental practitioners and 75 other specialists (nonendodontists). Results: In the present study, the authors observed that the knowledge level among the study participants was moderately satisfying. However, the need for more education of the dentists with regard to the intracanal medicaments was perceived. Discussion: Correct knowledge of intracanal medicaments would help the practitioners to decide the apt material of choice as intracanal medicaments in different clinical situations. Conclusion: The present study highlighted the need for more continuing dental education programs with active participation of general practitioners and nonendodontic specialists to update themselves.

Keywords: Antibiotics, calcium hydroxide, disinfection of root canal, intracanal medicaments, steroids

How to cite this article:
Manohar MP, Sharma S. A survey of the knowledge, attitude, and awareness about the principal choice of intracanal medicaments among the general dental practitioners and nonendodontic specialists. Indian J Dent Res 2018;29:716-20

How to cite this URL:
Manohar MP, Sharma S. A survey of the knowledge, attitude, and awareness about the principal choice of intracanal medicaments among the general dental practitioners and nonendodontic specialists. Indian J Dent Res [serial online] 2018 [cited 2019 Jan 18];29:716-20. Available from: http://www.ijdr.in/text.asp?2018/29/6/716/248255

   Introduction Top


Bacteria play a major role in the formation and progression of pulpal and periapical diseases.[1],[2],[3],[4] Bacteria can exist within the root canal itself or within other related regions such as the accessory canals, and apical deltas.[5] Removal of the microbial organisms from the root canal system is a prerequisite for the successful outcome of any root canal treatment. Apart from the canal, most other areas are inaccessible to mechanical instrumentation procedures and to the irrigating solutions used during endodontic treatment. Chemomechanical cleaning and shaping of the root canals greatly reduce the number of bacteria, but it has been shown that it is impossible to obtain complete disinfection in all cases.[6],[7] To completely eliminate as many bacteria as possible from the entire root canal system, a combination of mechanical instrumentation and irrigating solutions is used to remove or dissolve organic and inorganic debris, to destroy bacteria, to remove the smear layer, and to maintain dentine permeability.[5] Use of an effective intracanal medicament will assist in the disinfection of the root canal system. Such medication should be effective throughout its period of application and penetrate the dentinal tubules, eliminating bacteria that may be present, with little toxicity to the periradicular tissues.[1],[3] Intracanal medicaments have been used to disinfect root canals between appointments and reduce the interappointment pain.[8]

Intracanal medicaments can be divided into phenolic compounds such as crestatin, camphorated monochlorophenol, and aldehydes such as formocresol and glutaraldehyde, as well as other materials such as calcium hydroxide and some antibiotics.[9] These compounds are potent antibacterial agents under laboratory test conditions, but their efficacy in clinical use is unpredictable.[8] Intracanal medications have also been used clinically to prevent posttreatment pain. However, few studies have shown that the routine use of intracanal medications has no significant effect on the prevention of pain.[8],[10]

The objectives of the present study were as follows:

  • To evaluate the knowledge, attitude, and awareness about the choice of intracanal medicaments among general dental practitioners and nonendodontic specialists
  • To assess the material of choice as intracanal medicament by general practitioners and nonendodontic specialists.



   Materials and Methods Top


A validated and structured questionnaire containing 11 questions was framed. The questionnaire was distributed to general practitioners and specialists other than endodontist. Questionnaires were distributed to the dentists either by e-mail or handed over personally. The total number of questionnaires distributed among the dentists was 180, of which the total number of dentists who answered the questionnaire was 150, comprising of 75 general dentists and 75 nonendodontists, who were specialized in fields of dentistry other than Endodontics. The response rate was therefore 83.33%. The participants ranged from freshly passed out general practitioners who were abreast of the latest technologies to the elderly practitioners who based their practice on not so up-to-date treatment strategies. The study was conducted and the data were compiled within a period of 6 months. Data were analyzed using SPSS Version 17 (Statistical Program for the Social Sciences software (version 17.0).


   Results Top


The present study was conducted on 150 dentists (75 general practitioners and 75 nonendodontists). The mean age of the participants was 38.01 ± 7.04 years and 26.27 ± 1.48 years for the nonendodontists and general practitioners, respectively [Table 1].
Table 1: Profile of study participants

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[Figure 1] shows the sex distribution among the study participants who were general dentists (females: 30.7% and males: 69.3%) and nonendodontists (females: 64% and males: 36%).
Figure 1: Sex distribution across practices

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[Table 2] summarizes the knowledge about intracanal medicaments among the general practitioners and other specialists (nonendodontists) who participated in the study. It was not statistically significantly different in both the groups with regard to the knowledge on indications for intracanal medicaments, role of intracanal medicaments in damaging periodical tissue, and functions and uses of intracanal medications.
Table 2: Knowledge about intracanal medicaments among general practitioners and other specialists (nonendodontists)

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[Figure 2] shows the various indications for intracanal medication which varied with the type of practice.
Figure 2: Indications for intracanal medication by type of practice

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The knowledge about the characteristics of various intracanal medicaments and the practices related to the use of intracanal medicaments was also studied among the nonendodontists and general dental practitioners [Table 3] and [Table 4]. No statistically significant differences were observed in the knowledge and practices related to intracanal medicaments between the nonendodontists and general dental practitioners.
Table 3: Knowledge about characteristics of intracanal medications

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Table 4: Practices related to use of intracanal medicaments among general practitioners and other specialists (nonendodontists)

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   Discussion Top


Correct knowledge of intracanal medicaments would help the practitioners to decide the apt material of choice as intracanal medicaments in different clinical situations. In the present study, calcium hydroxide was the most popular interappointment dressing material of choice (65.3%). However, other medications such as iodoform (13%) and steroids (1%–2%) were also used.

Calcium hydroxide is a substance that inhibits microbial growth in canals.[11] The antibacterial effect of it is due to its alkaline pH. It also dissolves necrotic tissue remnants and bacteria and their by-products.[12] It can be placed as a dry powder, a powder mixed with liquids such as water, saline, local anesthetic or glycerin, or a proprietary paste supplied in a syringe.[9] Because of its toxicity, Ca(OH)2 should be placed within the canal with the aid of a file or a needle.[13] Extrusion of the material into the periapical tissues can cause tissue necrosis and pain for the patient.

Corticosteroids are anti-inflammatory agents that have been advocated as intracanal medicaments to reduce postoperative pain.[14] An animal study has shown a reduction of inflammatory cells in periapical tissues following supraperiosteal infiltration of dexamethasone into the buccal vestibule of rats.[15] There is no significant clinical evidence that suggests that they are effective in patients with very high pain levels.[16] The use of corticosteroids in patients with irreversible pulpitis and symptomatic apical periodontitis might be beneficial.[14],[17]

Root canal infections are polymicrobial, consisting of both aerobic and anaerobic bacteria, so it is unlikely that any single antibiotic could result in effective sterilization of the canal. A combination would be needed to address the diverse flora encountered. The most commonly used medicament is a combination of three antibiotics, referred to as a triple antibiotic paste. This formulation was first used by Sato et al. and contains metronidazole, ciprofloxacin, and minocycline. This combination is commercially available as 3-MIX MP.[18] Metronidazole is a nitroimidazole compound. It is selectively toxic to anaerobic microbes.[19] Minocyclines are primarily bacteriostatic. It inhibits collagenases and matrix metalloproteinases and is not cytotoxic. It also increases the level of interleukin-10, an anti-inflammatory cytokine.[20] Ciprofloxacin is a synthetic fluoroquinolone with rapid bactericidal action. Most of the anaerobic bacteria are resistant to ciprofloxacin. Hence, it is often combined with metronidazole in treating mixed infections.

Few root canal dressing materials consist of various organic components such as paraformaldehyde, chlorophenol, parachlorophenol, creosote, arsenic anhydride, and iodoform which are highly toxic, allergic, mutagenic, and carcinogenic to the patients.

The present study showed that the usage of intracanal medicaments should always be given after the completion of cleaning and shaping (85%–89%). According to the present study, the duration of use of intracanal medicament should be 2–4 days (44–46%) followed by 1 week (20-26%). The current study also showed that intracanal medicaments would cause damage to the peri-apical tissue (30–35%) which might be attributed to its alkaline pH.


   Conclusion Top


The cohort selected in the present study might not be truly representative of the general dental population throughout Chennai. However, the authors collected the data on the knowledge about intracanal medicaments among general practitioners and nonendodontic specialists. The present study revealed that there was no significant difference in knowledge about intracanal medicaments among both the general dental practitioners and nonendodontists. The present study highlighted the need for more continuing dental education programs with active participation of general practitioners and nonendodontic specialists to update themselves.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Kakehashi S, Stanley HR, Fitzgerald RJ. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol 1965;20:340-9.  Back to cited text no. 1
    
2.
Möller AJ, Fabricius L, Dahlén G, Sundqvist G, Happonen RP. Apical periodontitis development and bacterial response to endodontic treatment. Experimental root canal infections in monkeys with selected bacterial strains. Eur J Oral Sci 2004;112:207-15.  Back to cited text no. 2
    
3.
Dahlén G, Fabricius L, Heyden G, Holm SE, Möller AJ. Apical periodontitis induced by selected bacterial strains in root canals of immunized and nonimmunized monkeys. Scand J Dent Res 1982;90:207-16.  Back to cited text no. 3
    
4.
Fabricius L, Dahlén G, Holm SE, Möller AJ. Influence of combinations of oral bacteria on periapical tissues of monkeys. Scand J Dent Res 1982;90:200-6.  Back to cited text no. 4
    
5.
Abbott PV. Medicaments: Aids to success in endodontics. Part 1. A review of the literature. Aust Dent J 1990;35:438-48.  Back to cited text no. 5
    
6.
El Karim I, Kennedy J, Hussey D. The antimicrobial effects of root canal irrigation and medication. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:560-9.  Back to cited text no. 6
    
7.
Byström A, Sundqvist G. Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. Scand J Dent Res 1981;89:321-8.  Back to cited text no. 7
    
8.
Torabinejad M, Handysides R, Khademi AA, Bakland LK. Clinical implications of the smear layer in endodontics: A review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:658-66.  Back to cited text no. 8
    
9.
Johnson WT, Noblett WC. Cleaning and shaping. In: Endodontics: Principles and Practice. 4th ed. Philadelphia, PA: Saunders; 2009.  Back to cited text no. 9
    
10.
Wesselink PR, Thoden van Velzen SK, van den Hooff A. Tissue reaction to implantation of unfixed and glutaraldehyde-fixed heterologous tissue. J Endod 1977;3:229-35.  Back to cited text no. 10
    
11.
Law A, Messer H. An evidence-based analysis of the antibacterial effectiveness of intracanal medicaments. J Endod 2004;30:689-94.  Back to cited text no. 11
    
12.
Yang SF, Rivera EM, Baumgardner KR, Walton RE, Stanford C. Anaerobic tissue-dissolving abilities of calcium hydroxide and sodium hypochlorite. J Endod 1995;21:613-6.  Back to cited text no. 12
    
13.
Badr AE, Omar N, Badria FA. A laboratory evaluation of the antibacterial and cytotoxic effect of liquorice when used as root canal medicament. Int Endod J 2011;44:51-8.  Back to cited text no. 13
    
14.
Ehrmann EH, Messer HH, Adams GG. The relationship of intracanal medicaments to postoperative pain in endodontics. Int Endod J 2003;36:868-75.  Back to cited text no. 14
    
15.
Nobuhara WK, Carnes DL, Gilles JA. Anti-inflammatory effects of dexamethasone on periapical tissues following endodontic overinstrumentation. J Endod 1993;19:501-7.  Back to cited text no. 15
    
16.
Trope M. Relationship of intracanal medicaments to endodontic flare-ups. Endod Dent Traumatol 1990;6:226-9.  Back to cited text no. 16
    
17.
Chance KB, Lin L, Skribner JE. Corticosteroid use in acute apical periodontitis: A review with clinical implications. Clin Prev Dent 1988;10:7-10.  Back to cited text no. 17
    
18.
Sato I, Ando-Kurihara N, Kota K, Iwaku M, Hoshino E. Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ. Int Endod J 1996;29:118-24.  Back to cited text no. 18
    
19.
Tripathi KD. Essentials of Medical Pharmacology. 5th ed. New Delhi: Jaypee Brothers Medical publishers(P) LTD; 1985.  Back to cited text no. 19
    
20.
Ramamurthy NS, Rifkin BR, Greenwald RA, Xu JW, Liu Y, Turner G, et al. Inhibition of matrix metalloproteinase-mediated periodontal bone loss in rats: A comparison of 6 chemically modified tetracyclines. J Periodontol 2002;73:726-34.  Back to cited text no. 20
    

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Correspondence Address:
Dr. Madhu Priya Manohar
Saveetha Dental College, Saveetha University, Tamil Nadu, Chennai - 600 077
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_716_16

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    Figures

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