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

58 ENDODONTOLOGY ENDODONTOLOGY ENDODONTOLOGY ENDODONTOLOGY ENDODONTOLOGY 58 Antibacterial efficacy of aloe vera extract on resistant antimicrobial strains in endodontics B. SURESHCHANDRA * ARUN J. KUMAR ** * Professor and Head, ** PG student, Department of Conservative Dentistry and Endodontics, A.J. Institute of Dental Sciences, Mangalore. ABSTRACT 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 Elimination of the microorganisms and prevention of reinfection within the pulp canal are the main objectives of the pulp space therapy. Due to the complex anatomy of the pulp space system and the ability of microorganisms to survive in the periods of starvation, the microorganisms remain even after thorough mechanical instrumentation and irrigational procedures. Therefore an antimicrobial intracanal medicament is needed to eliminate the surviving resistant microorganisms. In many parts of the world, there is a rich tradition to use herbal medicine for the treatment of many infectious diseases.

In developing countries, it is estimated that about 80 percent of the population rely on traditional medicine for their primary health care. Due to the side effects and the resistance that pathogenic microorganisms build against the common antibiotics, much recent attention has been paid to extracts and biologically active compounds isolated from plants used in herbal medicine. Also researchers have shown that the use of herbal drugs have increased instead of synthesized drugs.

Aloe barbadensis Miller (Aloe Vera) belong to the liliaceal family, of which there are about 360 species. It is a cactus like plant that grows in hot and dry climates. Numerous studies on Aloe vera are being done to demonstrate the antiviral, antibacterial, and not to mention its other use as an analgesic, anti-inflammatory, wound healing properties. Aloe Vera has various therapeutic uses in cases such as-Arthritis, Asthma, Digestive and bowel disorders, skin problems.(eg: eczema, psoriasis, acne, burns) ,Ulcers etc in general. In dentistry Aloe vera is used in cases of Apthous ulcers, Lichen planus , Alveolar osteitis.

Enterococcus faecalis has been associated with failure of pulp space therapy.It has been shown that enterococcus faecalis may tolerate antibacterial Original Research

59 ENDODONTOLOGY ENDODONTOLOGY ENDODONTOLOGY ENDODONTOLOGY ENDODONTOLOGY 59 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 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.

PROCEDURE ALOE VERA EXTRACTION PROCEDURE Fig 1: Remove pulp from the leaf Fig 2: Converted into a juice form Fig 6: Dissolve it with corresponding Liquid extract media Fig 5: Precipitate of respective extract Fig 4: The mixed solution was placed in a crucible on a water bath for dehydration Fig 3: Mixed it well with corresponding liquid extract media in 1:5 ratio B. SURESHCHANDRA, ARUN J. KUMAR

60 ENDODONTOLOGY ENDODONTOLOGY ENDODONTOLOGY ENDODONTOLOGY ENDODONTOLOGY 60 AGAR DIFFUSION TEST PROCEDURE Fig 7: Armamentarium Fig 8: Inoculation of microbial test specimen Fig 9: Nipping out a hole Fig 10: Injecting the Aloe vera and calcium hydroxide paste Fig 11: Placed in an anaerobic jar Fig 16:Water extract of Aloe vera Fig 15: Results with E.

Faecalis; Methanol extract with Zone of Inhibition seen(12mm) Fig 14: Results with E. Faecalis;Chloroform extract of aloe vera with Zone of inhibition seen(9 mm) Fig 12: Placed in an incubator at 37o C for 24 hours Fig 13: Results with Candida Albicans; Zone of inhibition seen with Chloroform extract (14mm) ANTIBACTERIAL EFFICACY OF ALOE VERA EXTRACT ON RESISTANT ANTIMICROBIAL STRAINS IN ENDODONTICS

61 ENDODONTOLOGY ENDODONTOLOGY ENDODONTOLOGY ENDODONTOLOGY ENDODONTOLOGY 61 Fig 18: Calcium hydroxide Fig 17: Ether extract of Aloe vera Microbial Strains Candida Albicans E. faecalis Test No. 1. 2. 3. 4. 5. 1. 2. 3. 4. 5. Water Extract Alcohol extract 14mm 12mm 10mm 13mm 11mm Chloroform extract 14mm 13mm 13mm 15mm 15mm 9mm 7mm 10mm 10mm 9mm Ether Extract Calcium hydroxide Results of antimicrobial activity of different extracts of aloe vera and calcium hydroxide pastes DISCUSSION Agar diffusion test is generally accepted procedure.But has some limitations like pH of the substrate, incubation period, and diffusion capacity of the drug having effect on activity of test materials.

However evidence also suggests agar diffusion tests shows good correlation with other antimicrobial susceptibility tests. Natural extract of aloe vera is always better than commercially available aloe vera products, as no preservatives are added in the former one which may give biased results.

In this in-vitro study, the average zone of inhibition with chloroform extract of aloe vera against Candida albicans was found to be 14mm, against E.faecalis was 9mm. The average zone of inhibition with methanol extract of aloe vera against E. faecalis was found to be 12mm. These results were in agreement with the studies done by Sema Agaoglu et al, and Agarry O.O et al. Results achieved with alcohol and chloroform extracts may suggest the components of aloe vera are more soluble in those liquid extract media. CONCLUSION Aloe vera has shown antimicrobial effect against resistant microorganisms found in pulp space.

The antimicrobial activity of alcohol and chloroform extract could be due to the high solubility of active ingredients in these liquid extract media. Further in-vivo studies should be carried out to bring this plant in use in endodontics. B. SURESHCHANDRA, ARUN J. KUMAR

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