The mechanical instrumentation must be augmented with antimicrobial irrigant. Sodium hypochlorite - similar to Clorox Bleach - is almost universally the irrigant of choice in root canal treatment, and has been for many, many years. Various strengths of it are used but the research shows a wide range of helpful dilutions with not much difference in effect. It is very helpful for a couple of reasons. First it is highly antimicrobial for the vast majority of bacteria, viruses, spores, fungi and protozoa found in root canals. Secondly it chemically helps to actually "dissolve" remaining bits of tissue that could not be removed with the metal instruments. It is the only irrigant that can disrupt and remove microbial biofilm from the infected root canal system. Research, however, has shown that Sodium hypochlorite, while almost universally depended on, will not completely kill all the bacteria in the tooth in up to at least 50% of cases studied. Research over many, many years has shown that the addition of Calcium hydroxide as a medication inside the canal significantly further reduced bacteria.
Other medications commonly used like CMCP or phenol only succeeded in about 66% of cases. Other research using Calcium Hydroxide, but for SHORTER periods of time, like one or two weeks, showed no significant improved effectiveness over the CMCP or Phenol. It seems very important to me to leave the Calcium Hydroxide in the canals for at least 4 weeks for maximum effectiveness.
While Calcium Hydroxide does many wonderful things, it has been found to lack in one area. There are two microbes important in root canal treatment that it does not kill: Candida and E- faecalis. When root canal treatment fails as it sometimes does, very often E faecalis is found in the re-infected canals and it is often thought to be responsible for the failure. Fortunately, chlorhexidine has been found to be very effective against it.
Mixtures of chlorhexidine and Calcium Hydroxide have been shown to have additive benefit against Candida and E- faecalis. That is, the mixture is more effective than either one alone. It's effective in reducing discomfort and promoting good healing.
Chlorhexidine, which is seen or used in the form of "Peridex", a prescription mouth rinse for periodontal problems, can be used along with Sodium hypochlorite as a canal irrigant. It is safe and innocuous except to the germs that reside in the mouth and root canals!
Other medications commonly used like CMCP or phenol only succeeded in about 66% of cases. Other research using Calcium Hydroxide, but for SHORTER periods of time, like one or two weeks, showed no significant improved effectiveness over the CMCP or Phenol. It seems very important to me to leave the Calcium Hydroxide in the canals for at least 4 weeks for maximum effectiveness.
While Calcium Hydroxide does many wonderful things, it has been found to lack in one area. There are two microbes important in root canal treatment that it does not kill: Candida and E- faecalis. When root canal treatment fails as it sometimes does, very often E faecalis is found in the re-infected canals and it is often thought to be responsible for the failure. Fortunately, chlorhexidine has been found to be very effective against it.
Mixtures of chlorhexidine and Calcium Hydroxide have been shown to have additive benefit against Candida and E- faecalis. That is, the mixture is more effective than either one alone. It's effective in reducing discomfort and promoting good healing.
Chlorhexidine, which is seen or used in the form of "Peridex", a prescription mouth rinse for periodontal problems, can be used along with Sodium hypochlorite as a canal irrigant. It is safe and innocuous except to the germs that reside in the mouth and root canals!
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