Antibacterial efficacy of aloe vera extract on resistant antimicrobial strains in endodontics

ENDODONTOLOGY                                                                                                                          Original Research

                            Antibacterial efficacy of aloe vera extract on resistant
                            antimicrobial strains in endodontics

                            B. SURESHCHANDRA *
                            ARUN J. KUMAR **

  The use of aloe vera is being promoted for a large variety of clinical conditions. The aloe vera plant has a long
  history of therapeutic ability. Recently, aloe vera has gained some popularity as an active ingredient in tooth gel.
  The ability of aloe vera tooth gel to successfully perform its function has been a point of contention for some
  dental professionals. In this in-vitro study, the antimicrobial effect of water, alcohol, chloroform extracts of aloe
  vera gel were investigated on different strains of bacteria and yeasts. The results were then evaluated.
  Keywords: Aloe vera;Enterococcus faecalis;Antibacterial strains.

INTRODUCTION                                                                            herbal medicine. Also researchers have shown that
       Elimination of the microorganisms and                                            the use of herbal drugs have increased instead of
prevention of reinfection within the pulp canal are                                     synthesized drugs.
the main objectives of the pulp space therapy. Due
                                                                                                Aloe barbadensis Miller (Aloe Vera) belong
to the complex anatomy of the pulp space system
                                                                                        to the liliaceal family, of which there are about 360
and the ability of microorganisms to survive in the
                                                                                        species. It is a cactus like plant that grows in hot
periods of starvation, the microorganisms remain
                                                                                        and dry climates. Numerous studies on Aloe vera
even after thorough mechanical instrumentation
                                                                                        are being done to demonstrate the antiviral,
and irrigational procedures. Therefore an
                                                                                        antibacterial, and not to mention its other use as
antimicrobial intracanal medicament is needed to
                                                                                        an analgesic, anti-inflammatory, wound healing
eliminate the surviving resistant microorganisms.
       In many parts of the world, there is a rich
                                                                                                Aloe Vera has various therapeutic uses in cases
tradition to use herbal medicine for the treatment
                                                                                        such as-Arthritis, Asthma, Digestive and bowel
of many infectious diseases. In developing
                                                                                        disorders, skin problems.(eg: eczema, psoriasis,
countries, it is estimated that about 80 percent of
                                                                                        acne, burns) ,Ulcers etc in general.
the population rely on traditional medicine for their
primary health care. Due to the side effects and                                                In dentistry Aloe vera is used in cases of
the resistance that pathogenic microorganisms build                                     Apthous ulcers, Lichen planus , Alveolar osteitis.
against the common antibiotics, much recent                                             Enterococcus faecalis has been associated with
attention has been paid to extracts and biologically                                    failure of pulp space therapy.It has been shown that
active compounds isolated from plants used in                                           enterococcus faecalis may tolerate antibacterial

* Professor and Head, ** PG student, Department of Conservative Dentistry and Endodontics, A.J. Institute of Dental Sciences, Mangalore.

ENDODONTOLOGY                                                                                    B. SURESHCHANDRA, ARUN J. KUMAR

effect of Calcium Hydroxide treatment.

     Another resistant microorganism is Candida
Albicans, which has dentinophilic properties and
affinity to smear layer.Candida Albicans has
frequently isolated from failed cases as
Enterococcus Faecalis.Not surprisingly, Candida
Albicans can also survive in root canals after
adequate cleaning and shaping and Calcium
Hydroxide treatment.

     Many people are looking towards nature for                      Fig 3: Mixed it well with corresponding
                                                                         liquid extract media in 1:5 ratio
answers to their present health challenges. Aloe
Vera plant has a long history of therapeutic ability
and therfore has been promoted to combat large
variety of clinical conditions.

                                                             Fig 4: The mixed solution was placed in a crucible on a
                                                                           water bath for dehydration

             Fig 1: Remove pulp from the leaf
                                                                      Fig 5: Precipitate of respective extract

             Fig 2: Converted into a juice form

                                                            Fig 6: Dissolve it with corresponding Liquid extract media



                   Fig 7: Armamentarium

                                                                                   Fig 12: Placed in an incubator at 37oC for 24 hours

        Fig 8: Inoculation of microbial test specimen

                                                                            Fig 13: Results with Candida Albicans; Zone of inhibition seen
                                                                                            with Chloroform extract (14mm)

                  Fig 9: Nipping out a hole                                 Fig 14: Results with E. Faecalis;Chloroform extract of aloe vera
                                                                                          with Zone of inhibition seen(9 mm)

 Fig 10: Injecting the Aloe vera and calcium hydroxide paste                   Fig 15: Results with E. Faecalis; Methanol extract with Zone of
                                                                                                 Inhibition seen(12mm)

             Fig 11: Placed in an anaerobic jar                                               Fig 16:Water extract of Aloe vera

ENDODONTOLOGY                                                                                                          B. SURESHCHANDRA, ARUN J. KUMAR

                  Fig 17: Ether extract of Aloe vera                                              Fig 18: Calcium hydroxide

Microbial Strains       Test No.      Water Extract      Alcohol extract       Chloroform extract       Ether Extract        Calcium hydroxide
Candida Albicans            1.               -                    -                   14mm                      -                      -
                            2.               -                    -                   13mm                      -                      -
                            3.               -                    -                   13mm                      -                      -
                            4.               -                    -                   15mm                      -                      -
                            5.               -                    -                   15mm                      -                      -
    E. faecalis             1.               -                14mm                     9mm                      -                      -
                            2.               -                12mm                     7mm                      -                      -
                            3.               -                10mm                    10mm                      -                      -
                            4.               -                13mm                    10mm                      -                      -
                            5.               -                11mm                     9mm                      -                      -

                         Results of antimicrobial activity of different extracts of aloe vera and calcium hydroxide pastes

DISCUSSION                                                                   against E.faecalis was 9mm. The average zone of
     Agar diffusion test is generally accepted                               inhibition with methanol extract of aloe vera against
procedure.But has some limitations like pH of the                            E. faecalis was found to be 12mm. These results
substrate, incubation period, and diffusion capacity                         were in agreement with the studies done by Sema
of the drug having effect on activity of test materials.                     Agaoglu et al, and Agarry O.O et al. Results
                                                                             achieved with alcohol and chloroform extracts may
     However evidence also suggests agar diffusion
                                                                             suggest the components of aloe vera are more
tests shows good correlation with other
                                                                             soluble in those liquid extract media.
antimicrobial susceptibility tests. Natural extract of
aloe vera is always better than commercially                                 CONCLUSION
available aloe vera products, as no preservatives                                   Aloe vera has shown antimicrobial effect
are added in the former one which may give biased                            against resistant microorganisms found in pulp
results.                                                                     space. The antimicrobial activity of alcohol and
                                                                             chloroform extract could be due to the high
     In this in-vitro study, the average zone of
                                                                             solubility of active ingredients in these liquid extract
inhibition with chloroform extract of aloe vera
                                                                             media. Further in-vivo studies should be carried
against Candida albicans was found to be 14mm,
                                                                             out to bring this plant in use in endodontics.

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