Rh2 and Ca(OH)2 Combo: Promising Treatment for Root Canal Infections
Introduction
Apical periodontitis, an inflammatory disease affecting tooth apex tissues, is triggered by oral pathogens infecting the root canal. One of the main reason for endodontic treatment failure is Enterococcus (E.) faecalis, a pathogenic bacterium that has extremely high tolerance to the most often used root canal dressing calcium hydroxide (Ca(OH)2). Ginsenoside Rh2, a Chinese herbal extract, has been affirmed to possess anti-microbial properties and synergistic activities. The combination of Rh2 with Ca(OH)2 appears to be a potential alternative to root canal treatment.
About E. faecalis
E. faecalis is a facultative anaerobic gram-positive bacterium, which has been deemed as the main pathogenic factor of refractory periapical infections. This bacterium can survive for a long time by forming a biofilm with very strong adhesion in a hostile environment, and is resistant to the mechanical cleaning and the medications for root canal disinfection.
The synergistic antibacterial activities of Rh2 and Ca(OH)2 against E. faecalis.
Rh2 has the potential to enhance the ability of Ca(OH)2 to eradicate E. faecalis and its biofilms in root canals by disrupting the cell membrane and inhibiting the proton transport system on the bacterial surface. The removal of mature bioflims by Rh2 is mainly achieved by removing extracellular polysaccharides and inhibiting bacterial activity. Specifically, Rh2 significantly inhibits H+/K+-ATPase activity of E. faecalis with increasing drug concentration, thus inhibiting the exocytosis of −OH from Ca(OH)2. Strikingly, neither Rh2 nor its combination with Ca(OH)2 shows toxicity to L929 cells at effective antimicrobial activity concentrations.
Conclusion
Rh2 is a phytochemical substance, with the merits of low cytotoxicity, high efficiency and reproducibility, stable quality, and enhancement of the efficacy of antagonistic drugs. Ginsenoside Rh2 and Ca(OH)2 exert a synergistic antibacterial effect on E. faecalis, providing novel insights into the development of root canal treatment drugs.
Reference
Liu C, Li Y, Li Y, Li Z, Han G. Synergistic antibacterial effect of ginsenoside Rh2 and Ca(OH)2 on Enterococcus faecalis. Odontology. Published online May 19, 2024. doi:10.1007/s10266-024-00951-zBONTAC Ginsenosides
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