[Downloaded free from http://www.drjjournal.net on Monday, March 5, 2018, IP: 109.228.165.

241]

Dental Research Journal

Original Article
A comparative evaluation of Morinda citrifolia, green tea polyphenols,
and Triphala with 5% sodium hypochlorite as an endodontic irrigant
against Enterococcus faecalis: An in vitro study
A. R. Divia1, Mali G. Nair1, Jolly Mary Varughese2, Shobha Kurien3
Department of Conservative Dentistry and Endodontics, Government Dental College, 3Department of Microbiology, Government Medical College,
1

Thiruvananthapuram, 2Department of Conservative Dentistry and Endodontics, Government Dental College, Thrissur, Kerala, India

ABSTRACT
Background: Endodontic infections require effective removal of microorganisms from the root
canal system for long‑term prognosis. Sodium hypochlorite (NaOCl) is the most effective irrigant
currently, but potential complications due to its toxicity warrant search for newer alternatives. In
this study, the antimicrobial efficacy of Morinda citrifolia (MC), green tea polyphenols and Triphala
was compared with 5% NaOCl against Enterococcus faecalis.
Materials and Methods: In this in vitro study sixty extracted human premolar teeth were infected
with E. faecalis, a Group D Streptococci for 48 h. At the end of 48 h, the vital bacterial population
was assessed by counting the number of colony‑forming units (CFUs) on blood agar plate. Samples
were divided into five groups; Group I (distilled water), Group II (NaOCl), Group III (MC),
Group IV (Triphala), and Group V (green tea polyphenols).The samples were irrigated with individual
test agents and CFUs were recorded. Kruskal–Wallis test was performed as the parametric test
to compare different groups. Student’s t‑test was used to compare mean values between groups
before and after treatment with test agents (P < 0.001).
Received: July 2016 Results: NaOCl was the most effective irrigant the elimination of E. faecalis reinforcing its role as
Accepted: August 2017
the best irrigant available currently and a gold standard for comparison of the experimental groups.
Address for correspondence: Its antibacterial effect was comparable to Triphala. Among the experimental groups, MC showed
Dr. A. R. Divia, the minimum antibacterial effect.
Attuvalappil House,
P. O. Puranattukara,
Conclusion: The use of herbal alternatives as a root canal irrigant might prove to be advantageous
Thrissur ‑ 680 551, Kerala, considering the several undesirable characteristics of NaOCl.
India.
E‑mail: [email protected] Key Words: Enterococcus faecalis, green tea, Morinda citrifolia, sodium hypochlorite, Triphala

INTRODUCTION Elimination of these microorganisms from root canal

system is one of the main objectives of the root canal
Primary endodontic infections are caused by oral treatment.[1] However, microorganisms may remain
microorganisms, which are usually opportunistic after conventional canal preparation, either within
pathogens that may invade a root canal containing
This is an open access article distributed under the terms of the Creative
necrotic tissue and establish an infectious process. Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which
allows others to remix, tweak, and build upon the work non‑commercially,
as long as the author is credited and the new creations are licensed under
Access this article online the identical terms.

For reprints contact: [email protected]

Website: www.drj.ir
www.drjjournal.net How to cite this article: Divia AR, Nair MG, Varughese JM, Kurien S.
www.ncbi.nlm.nih.gov/pmc/journals/1480 A comparative evaluation of Morinda citrifolia, green tea polyphenols, and
Triphala with 5% sodium hypochlorite as an endodontic irrigant against
Enterococcus faecalis: An in vitro study. Dent Res J 2018;15:117-22.

© 2018 Dental Research Journal | Published by Wolters Kluwer - Medknow 117

[Downloaded free from http://www.drjjournal.net on Monday, March 5, 2018, IP: 109.228.165.241]

Divia, et al.: Antimicrobial efficacy of herbal irrigants

the dentinal tubules or bound within the apical dentin without seed: Amalaki (Emblica officinalis), Bibhitaki
plug.[2] (Terminalia bellirica), and Haritaki (Terminalia chebula).
Formulations of Triphala has been claimed to have
One of the main causes of root canal therapy failure
antiviral and antibacterial effect, and the fruits that are
is the persistence of microorganisms and their
rich in citric acid may aid in removal of smear layer.[10]
reinfection. Sundqvist et al. recovered numerous
species of bacteria from failed root canal cases; of Green tea, the traditional drink of Japan and China,
which Enterococcus faecalis was found to be the most is prepared from the young shoots of the tea plant
prevalent bacteria.[3] Enterococci survive very harsh Camellia sinensis. Extracts of Japanese green tea
environments including extreme alkaline pH (9.6) may be useful as a medicament for the treatment of
and salt concentrations.[4] It can survive in well infected root canals.[11] Biocompatible irrigants are
instrumented and obturated root canals alone with needed to promote dental pulp stem cells (DPSCs)
scanty available nutrients and has the ability to resist attachment to root canal dentin, which is essential to
high pH because of its functioning proton pump which accomplish some regenerative endodontic therapies.
drives protons into the cell to acidify its cytoplasm.[5] Common endodontic irrigating solutions such as
NaOCl and chlorhexidine are cytotoxic to pulp cells
Cleaning of the root canal system using mechanical and oral tissues. Hence, more biocompatible irrigants
instrumentation alone is ineffective due to the extremely are suggested for use in cases planned for regenerative
complex root canal anatomy.[6] Hence, cleaning endodontics. MC juice (MCJ) and EDTA have been
and shaping should be accompanied by copious proved to help maintain the survival and attachment of
irrigation. The various irrigants used are sodium DPSCs to be used as part of regenerative endodontic
hypochlorite (NaOCl), Ethylenediaminetetraacetic treatment.[12] The aim of this study was to evaluate
acid (EDTA), citric acid, chlorhexidine gluconate, and compare the antimicrobial efficacy of MC, GTPs,
hydrogen peroxide, povidone‑iodine, etc.[7] and Triphala, with 5% NaOCl against E. faecalis.
Scientific evidence relating to the desirable properties of
an irrigant reveals that NaOCl is currently the irrigant MATERIALS AND METHODS
of choice and is preferred by most clinicians. However,
concerns as to its effect on vital tissues still persist. It In an in vitro study 60 freshly extracted human single
causes severe inflammation and cellular destruction in rooted premolars with matured apices and standard
all tissues, and when extrusion occurs through the apices strain of E. Faecalis (ATCC 29212) were selected for
of teeth, it causes severe pain, swelling, and necrosis.[8] the study. Irrigants used were commercially available
5% Sodium hypochlorite, distilled water, 17% EDTA,
Due to constant increase in antibiotic‑resistant strains fresh Morindacitrifolia fruits from which extract was
and the side effects caused by synthetic drugs, prepared, Green tea polyphenols (95% GTP, Herbal
there is the need for an alternative disinfecting solutions, India) and Triphala extract (100%, Organic
measure. To overcome the disadvantages of India Ltd). Microbiological media used were Mueller
currently known irrigants, use of herbal alternatives Hinton broth and Blood agar medium.
is suggested. The rationale of this study was to
The preparation of Morindacitrifolia extract was done.
find less toxic alternatives to currently available
Fresh fruits were chopped into pieces and dried at
irrigants. Herbal products tested in this study include
room temperature for 24 hrs. The air dried fruits were
Morinda citrifolia (MC) fruit extract, green tea
kept at 40°C in hot air oven for 24 hrs to remove
polyphenols (GTPs), and Triphala.
moisture content and ground into powder form by
MC, commercially known as noni, is considered as using mortar and pestle and mixed in a ratio of 1:5
an important folk medicine. Its juice contains the with solvent ethanol. The extraction was carried out
antibacterial compounds L‑asperuloside and alizarin. in a shaker water bath at 40°C for 48 hrs. The extract
Its juice has a broad range of therapeutic effects and was filtered through whatmann no: 1 filter paper,
its use as an irrigant might be advantageous because it concentrated to dryness and dissolved in required
is a biocompatible antioxidant and not likely to cause concentration in 10% dimethyl sulfoxide (DMSO).
severe injuries such as NaOCl accidents.[9]
The minimum inhibitory concentration of the
Triphala is an ayurvedic herbal rasayana formula different groups was determined by tube dilution
consisting of equal parts of three myrobalans, taken method. The extracts in powder form were dissolved

118 Dental Research Journal / Volume 15 / Issue 2 / March-April 2018

[Downloaded free from http://www.drjjournal.net on Monday, March 5, 2018, IP: 109.228.165.241]

Divia, et al.: Antimicrobial efficacy of herbal irrigants

at a concentration of 64 mg/ml in 10% DMSO, and Statistical analysis

serial dilution was carried out to find the minimum Student’s t‑test was used to compare mean
inhibitory concentration. Minimum bactericidal values between before and after treatment
concentration (MBC) was also determined. groups. Kruskal–Wallis test was performed as the
parametric test to compare different groups. For all
The MBC of NaOCl is 0.5%. The commonly used
statistical evaluations, a two‑tailed P < 0.05 was
concentration for root canal irrigation is 5%. Hence,
considered statistically significant.
the concentrations of other irrigants were also
adjusted accordingly. The solutions were prepared at
RESULTS
a concentration of 10 times their MBC.
For sample preparation, the selected teeth were When bacterial colony counts were done for the
decoronated at the cementoenamel junction using a teeth samples after inoculation of E. faecalis, the
diamond disc, to obtain approximately 13 mm length counts varied from 825 to 1119 CFU/µl. After the
of root samples and pulpal remnants were extirpated. test application of each agent, the CFU counts
The apices of teeth were sealed with glass ionomer of different groups were an average of Group I:
cement (Fuji IX, GC, Tokyo, Japan). The remaining 944.50 CFUs/µl, Group II: <1 CFUs/µl, Group III:
root surface was coated with a double layer of nail 158.17 CFUs/µl, Group IV: 15.92 CFUs/µl, and
varnish to isolate the internal root environment. Group V: 56.67 CFUs/µl [Figure 1a‑e].
Coronal flaring was done using Gates Glidden
Bacterial CFU counts for all the experimental
Drills (size 1–4), and apical preparation was done till
groups obtained after application of test agents were
ISO size 50 K‑file (Dentsply Maillefer, Ballaigues,
compared with the values attained before application
Switzerland). Copious irrigation was done with 5%
and were found to be statistically significant except
NaOCl, followed by 17% EDTA for 5 min each.
for the distilled water group. When the individual
Finally, canals were rinsed with 5 ml of normal saline
groups were compared before treatment, there was no
and stored in distilled water until use.
statistically significant difference (P > 0.05) between
The sixty samples were divided into five groups of 12 them. After test with individual irrigating agents, there
teeth each. The five Micro Tip boxes containing sixty was statistically significant difference (P < 0.001)
samples were sterilized at 121º C for 15 min at 15 between the groups. Group II (NaOCl) and
psi pressure in an autoclave. Assurance of negativity Group IV (Triphala) showed no statistically significant
was confirmed by culture testing. The bacteria difference after treatment; whereas the result was
suspension was then inoculated, and the samples statistically significant when Group II (NaOCl)
were incubated aerobically at 37°C in a biochemical and Group IV (Triphala) were compared with
oxygen demand (B O D) incubator for 48 h. After Group I (distilled water), Group III (MC) and
inoculation, the washable content of each root canal Group V (GTPs) after treatment [Tables 1 and 2].
was removed with sterile saline.
DISCUSSION
Sampling of the attached bacteria was done by
resuspending the bacteria in the sterile saline.
The successful culmination of endodontic therapy
A standard bacteriological loop (0.001 ml or 1 µl)
lies in delivering efficacious treatment to the
was dipped inside the root canal containing the saline
patient, which renders complete resolution of
and streaked onto the blood agar plate and incubated
pulpal or periapical pathosis. E. faecalisis is a
for 2 days at 37°C in a B O D incubator. After
nonspore‑forming, fermentative facultative anaerobic
incubation, the colony‑forming unit (CFU) counts for
Gram‑positive coccus that belongs to the Group D
all teeth were recorded using colony counter.
streptococci.[13] Studies investigated its occurrence
The teeth will be randomly divided into in root‑filled teeth with periradicular lesions and
five groups of 12 teeth each: Group I demonstrated a prevalence ranging from 24% to
(distilled water), Group II (NaOCl), Group III (MC), 77%.[14] E. faecalis was found in cases of failed
Group IV (Triphala), and Group V (GTPs). The endodontic therapy (67%) than in primary endodontic
teeth in different groups were irrigated with the infections (18%).[15] The pathogenicity is believed to
corresponding test solutions. After incubation, the be associated with its ability to produce cytolysin,
CFU counts for all teeth were recorded. a toxin that causes rupture of a variety of target

Dental Research Journal / Volume 15 / Issue 2 / March-April 2018 119

[Downloaded free from http://www.drjjournal.net on Monday, March 5, 2018, IP: 109.228.165.241]

Divia, et al.: Antimicrobial efficacy of herbal irrigants

a b c

d e
Figure 1: (a) Distilled water, (b) sodium hypochlorite, (c) Morinda citrifolia, (d) triphala, (e) green tea polyphenols.

Table 1: Comparison of mean colony forming unit a high percentage of root canal failures, and it is able
between test and control in different groups to survive in the root canal as a single organism or as
Group Treatment Mean±SD t P a major component of the flora.[16] Both culture and
Distilled Before treatment 948.33±71.17 0.132 >0.05 PCR methods are sensitive to detect E. faecalis in root
water After treatment 944.50±70.45 canals.[17] Considering the nature of the organism and
Sodium Before treatment 939.17±51.76 62.951 <0.001
hypochlorite
its capability to populate and survive in unsuccessful
After treatment 0.67±0.78
Morinda Before treatment 940.50±78.37 44.035 <0.001
cases of therapy, this organism assumes importance
citrifolia After treatment 158.17±19.83 and is an imperative choice for this study.
Triphala Before treatment 940.92±74.51 62.951 <0.001
NaOCl is the universally accepted irrigant of choice.
After treatment 15.92±2.87
Green tea Before treatment 980.67±93.39 33.716 <0.001
However, inadvertent injection beyond the root apex
polyphenols After treatment 56.67±7.18 can cause violent tissue reactions such as acute
SD: Standard deviation inflammation followed by necrosis.[18] Hypochlorite
preparations are sporicidal ad virucidal and show far
Table 2: Kruskal‑Wallis test comparing different greater tissue dissolving effects on necrotic than on vital
groups before and after treatment tissues.[19,20] To avoid extrusion, it is always prudent
Treatment Group Mean±SD H P to confirm the length and integrity of the root canal
Before Distilled water 948.33 ±71.17 1.173 >0.05
a system before irrigating with concentrated solutions.[21]
treatment Sodium hypochlorite 939.17a±51.76 Concentration as low as 1:1000 (v/v) NaOCl in saline
Morinda citrifolia 940.50a±78.34 caused complete hemolysis of red blood cells in vitro.[22]
Triphala 940.92a±74.51
Green tea polyphenols 980.67a±93.39 MC, the ‘‘noni’’ is considered as a panacea because
After Distilled water 944.50d±70.45 56.741 <0.001 of the profound claim on its medicinal uses in
treatment Sodium hypochlorite 0.67a±0.78 treating many diseases of microbial origin. Noni fruit
Morinda citrifolia 158.17c±19.83
contains numerous iridoids, and main compounds
Triphala 15.92a±2.87
Green tea polyphenols 56.67b±7.18
include asperuloside, asperulosidic acid, and
Means with the same superscript within each treatment do not differ each
a,b,c,d
deacetylasperulosidic acid.[23] The main organic acids are
other (Duncan’s Multiple Range Test). SD: Standard deviation capric and caprylic acids, whereas the principal alkaloid
is xeronine. In vitro research shown that noni has
membranes including bacterial cells, erythrocytes, antimicrobial, anticancer, antioxidant, anti‑inflammatory,
and other mammalian cells. It is commonly found in analgesic, and cardiovascular activity.[24]

120 Dental Research Journal / Volume 15 / Issue 2 / March-April 2018

[Downloaded free from http://www.drjjournal.net on Monday, March 5, 2018, IP: 109.228.165.241]

Divia, et al.: Antimicrobial efficacy of herbal irrigants

Studies indicate that 6% MCJ in combination with different test agents for 5 min followed by saline as a
EDTA can remove the smear layer from the walls of final irrigant, to eliminate prolonged contact time of
instrumented root canals.[25] A study suggested that each irrigant and to standardize the groups. Therefore,
biocompatible irrigants are needed to promote DPSC the potential carryover of antibacterial activity to the
attachment to root canal dentin, which is essential culture medium was also avoided. DMSO was used
for regenerative endodontic therapies.[7] It has as a solvent for MC fruit extract, Triphala, and GTP
antimicrobial action against Pseudomonas aeruginosa, which is a clean, safe, highly polar, aprotic solvent
Proteus morganii, Staphylococcus aureus, Bacillus that helps in bringing out the pure properties of all the
subtilis, Escherichia coli, Salmonella, Shigella, components of the herb being dissolved.[37]
E. faecalis, and Candida albicans.[26] Another study
Group II (NaOCl) was the most effective in
suggested that propolis and MCJ were effective
elimination of E. faecalis. Its antibacterial effect
against E. faecalis in dentin of extracted teeth.[27] MC
fruit extract had an antifungal effect on C. albicans was comparable to that of Group IV (Triphala).
and the inhibitory effect varied with concentration Group V (GTPs) and Group III (MC) also showed
and contact time.[28] a significant antibacterial effect. Among the test
agents, Group III (MC) showed the minimum
Green tea is prepared from unfermented leaves antibacterial effect. Triphala showed more potency
and is a rich source of polyphenols, particularly on E. faecalis biofilm. This may be attributed to its
flavonoids such as the catechins, catechingallates, formulation, which contains three different medicinal
and proanthocyanidins.[29] Many of the physiological plants in equal proportions. Tannic acid represents
activities reported for tea extracts have been found the major constituent of the ripe fruit of T. chebula,
to be due to the polyphenol moiety.[30] The fresh T. belerica, and E. officinalis. Earlier studies reported
leaves contain caffeine, theobromine, theophylline, that tannic acid is bacteriostatic and bactericidal to
and other methylxanthines such as lignin, organic some Gram‑positive and Gram‑negative pathogens.[38]
acids, chlorophyll, and free amino acids.[31] Many In this study, Triphala showed antibacterial activity
of the biological properties of green tea have been comparable to that of NaOCl which is a gold standard
ascribed to the catechin fraction, which constitutes up for comparison of root canal irrigants.
to 30% of the dry leaf weight.[32] In a study, Triphala,
GTPs, and mixture of Doxycycline, citric acid and CONCLUSION
a detergent (MTAD) showed statistically significant
antibacterial activity against E. faecalis biofilm Triphala, GTPs, and MC showed a significant
formed on tooth substrate.[33] antibacterial effect against E. faecalis. Among the
Triphala is a combination of three tropical fruits’ tested agents, Triphala was found to be as efficacious
preparation comprised of equal parts of T. chebula, as NaOCl. Herbal alternatives might prove to be
E. officinalis, and T. bellirica which possess advantageous considering the several undesirable
anti‑inflammatory, analgesic, and antiaging properties. properties of NaOCl. However, the preparation
A study evaluated the antimicrobial efficacy of Triphala, of fresh irrigating solutions, standardization, and
GTPs, and 3% of NaOCl against E. faecalis biofilm toxicity should be further evaluated before they are
formed on tooth substrate and concluded that NaOCl recommended for clinical use.
had maximum antibacterial activity against E. faecalis Financial support and sponsorship
biofilm formed on tooth substrate. Triphala and GTP Nil.
also showed significantly better antibacterial activity.[34]
Conflicts of interest
The in vitro model used in this study was The authors of this manuscript declare that they have
adapted from the one used by Haapasalo and no conflicts of interest, real or perceived, financial or
Orstavik.[35] Apical preparation was standardized to
non‑financial in this article.
number 50 K‑file (Dentsply Maillefer, Ballaigues,
Switzerland) and step‑back preparation was done. The REFERENCES
apical preparation with number. 50 K‑file aided in better
irrigant penetration and biomechanical preparation 1. Iqbal A. Antimicrobial irrigants in the endodontic therapy. Int J
standardized the internal diameter of the root canals.[36] Health Sci (Qassim) 2012;6:186‑92.
The root canals of all tooth samples were irrigated with 2. Al‑Nazhan S, Al‑Sulaiman A, Al‑Rasheed F, Alnajjar F,

Dental Research Journal / Volume 15 / Issue 2 / March-April 2018 121

[Downloaded free from http://www.drjjournal.net on Monday, March 5, 2018, IP: 109.228.165.241]

Divia, et al.: Antimicrobial efficacy of herbal irrigants

Al‑Abdulwahab B, Al‑Badah A, et al. Microorganism penetration chloramine‑T solutions in contact with necrotic and normal
in dentinal tubules of instrumented and retreated root canal walls. tissues in vivo. J Exp Med 1918;27:627‑33.
In vitro SEM study. Restor Dent Endod 2014;39:258‑64. 21. Gernhardt CR, Eppendorf K, Kozlowski A, Brandt M. Toxicity
3. Sundqvist G, Figdor D, Persson S, Sjögren U. Microbiologic of concentrated sodium hypochlorite used as an endodontic
analysis of teeth with failed endodontic treatment and the irrigant. Int Endod J 2004;37:272‑80.
outcome of conservative re‑treatment. Oral Surg Oral Med Oral 22. Pashley EL, Birdsong NL, Bowman K, Pashley DH. Cytotoxic
Pathol Oral Radiol Endod 1998;85:86‑93. effects of NaOCl on vital tissue. J Endod 1985;11:525‑8.
4. Tendolkar PM, Baghdayan AS, Shankar N. Pathogenic 23. Potterat O, Hamburger M. Morinda citrifolia (Noni)
enterococci: New developments in the 21st century. Cell Mol fruit – Phytochemistry, pharmacology, safety. Planta Med
Life Sci 2003;60:2622‑36. 2007;73:191‑9.
5. Evans M, Davies JK, Sundqvist G, Figdor D. Mechanisms 24. Chan‑Blanco Y, Vaillant F, Perez AM, Reynes M, Brillouet JM,
involved in the resistance of Enterococcus faecalis to calcium Brat P. The noni fruit (Morindacitrifolia L.): A review of
hydroxide. Int Endod J 2002;35:221‑8. agricultural research, nutritional and therapeutic properties.
6. Metzger Z, Solomonov M, Kfir A. The role of mechanical J Food Compost Anal 2006;19:645‑54.
instrumentation in the cleaning of root canals. Endod Topics 25. Murray PE, Farber RM, Namerow KN, Kuttler S, Garcia‑Godoy F.
2013;29:87‑109. Evaluation of Morinda citrifolia as an endodontic irrigant.
7. Bryce G, O’Donnell D, Ready D, Ng YL, Pratten J, Gulabivala K, J Endod 2008;34:66‑70.
et al. Contemporary root canal irrigants are able to disrupt and 26. Tyagi SP, Sinha DJ, Garg P, Singh UP, Mishra CC, Nagpal R,
eradicate single‑and dual‑species biofilms. J Endod 2009;35:1243‑8. et al. Comparison of antimicrobial efficacy of propolis,
8. Al‑Sebaei MO, Halabi OA, El‑Hakim IE. Sodium hypochlorite Morinda citrifolia, Azadirachta indica (Neem) and 5% sodium
accident resulting in life‑threatening airway obstruction during hypochlorite on Candida albicans biofilm formed on tooth
root canal treatment: A case report. Clin Cosmet Investig Dent substrate: An in‑vitro study. J Conserv Dent 2013;16:532‑5.
2015;7:41‑4. 27. Kandaswamy D, Venkateshbabu N, Gogulnath D, Kindo AJ.
9. Assi RA, Darwis Y, Abdulbaqi IM, Khan AA, Vuanghao L, Dentinal tubule disinfection with 2% chlorhexidine gel, propolis,
Laghari MH. Morinda citrifolia (Noni): A comprehensive review Morinda citrifolia juice, 2% povidone iodine, and calcium
on its industrial uses, pharmacological activities, and clinical hydroxide. Int Endod J 2010;43:419‑23.
trials. Arabian J Chem 2015;1:1‑17. 28. Jainkittivong A, Butsarakamruha T, Langlais RP. Antifungal
10. Bhavikatti SK, Dhamija R, Prabhuji ML. Triphala: Envisioning activity of Morinda citrifolia fruit extract against Candida
its role in dentistry. Int Res J Pharm 2015;6:309‑13. albicans. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
11. Horiba N, Maekawa Y, Ito M, Matsumoto T, Nakamura H. A pilot 2009;108:394‑8.
study of Japanese green tea as a medicament: Antibacterial and 29. Taylor PW, Hamilton‑Miller JM, Stapleton PD. Antimicrobial
bactericidal effects. J Endod 1991;17:122‑4. properties of green tea catechins. Food Sci Technol Bull
12. Ring KC, Murray PE, Namerow KN, Kuttler S, Garcia‑Godoy F. 2005;2:71‑81.
The comparison of the effect of endodontic irrigation on cell 30. Stagg GV, Millin DJ. The nutritional and therapeutic value of
adherence to root canal dentin. J Endod 2008;34:1474‑9. tea‑A review. J Sci Food Agric 1975;26:1439‑59.
13. Rôças IN, Siqueira JF Jr., Santos KR. Association of Enterococcus 31. Graham HN. Green tea composition, consumption, and
faecalis with different forms of periradicular diseases. J Endod polyphenol chemistry. Prev Med 1992;21:334‑50.
2004;30:315‑20. 32. Hara Y. Green Tea: Health Benefits and Applications. New York,
14. Siqueira JF Jr., Rôças IN. Exploiting molecular methods to USA: Marcel Dekker; 2001.
explore endodontic infections: Part 2 – Redefining the endodontic 33. Prabhakar J, Senthilkumar M, Priya MS, Mahalakshmi K,
microbiota. J Endod 2005;31:488‑98. Sehgal PK, Sukumaran VG, et al. Evaluation of antimicrobial
15. Rôças IN, Siqueira JF Jr., Aboim MC, Rosado AS. Denaturing efficacy of herbal alternatives (Triphala and green tea
gradient gel electrophoresis analysis of bacterial communities polyphenols), MTAD, and 5% sodium hypochlorite against
associated with failed endodontic treatment. Oral Surg Oral Med Enterococcus faecalis biofilm formed on tooth substrate: An
Oral Pathol Oral Radiol Endod 2004;98:741‑9. in vitro study. J Endod 2010;36:83‑6.
16. Stuart CH, Schwartz SA, Beeson TJ, Owatz CB. Enterococcus 34. Pujar M, Patil C, Kadam A. Comparison of antimicrobial
faecalis: Its role in root canal treatment failure and current efficacy of Triphala, Green tea polyphenols and 3% of sodium
concepts in retreatment. J Endod 2006;32:93‑8. hypochlorite on Enterococcus faecalis biofilms formed on tooth
17. Cogulu D, Uzel A, Oncag O, Aksoy SC, Eronat C. Detection of substrate: In vitro J Int Oral Health 2011;3:23-9.
Enterococcus faecalis in necrotic teeth root canals by culture and 35. Haapasalo M, Orstavik D. In vitro infection and disinfection of
polymerase chain reaction methods. Eur J Dent 2007;1:216‑21. dentinal tubules. J Dent Res 1987;66:1375‑9.
18. Kleier DJ, Averbach RE, Mehdipour O. The sodium hypochlorite 36. Ram Z. Effectiveness of root canal irrigation. Oral Surg Oral
accident: Experience of diplomates of the American board of Med Oral Pathol 1977;44:306‑12.
endodontics. J Endod 2008;34:1346‑50. 37. de la Torre JC. Biological actions and medical applications of
19. McDonnell G, Russell AD. Antiseptics and disinfectants: Activity, dimethyl sulfoxide. Ann N Y Acad Sci 1983;411:1‑403.
action, and resistance. Clin Microbiol Rev 1999;12:147‑79. 38. Jagadish L, Anand Kumar VK, Kaviyarasan V. Effect of Triphala
20. Austin JH, Taylor HD. Behavior of hypochlorite and of on dental bio‑film. Indian J Sci Tech 2009;2:30‑3.

122 Dental Research Journal / Volume 15 / Issue 2 / March-April 2018