BETHESDA, MARYLAND EFFECT OF ALCOHOL ON THE SPREADING AJ31LITY OF HYPOCHLORITE ENDOOONTIC IRRIGANT.

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1 )ia-val MEDICAL RESEARCH INSTITUTE BETHESDA, MARYLAND 1ýbSTAT f 'CL R ESE~ EFFECT OF ALCOHOL ON THE SPREADING AJ31LITY OF HYPOCHLORITE ENDOOONTIC IRRIGANT. W.T.Ct*ININGHAM, J-S-COLE,1I, AM) A.Y.BALEKJIAN DCD j. Vorosmarti, CAPT, MC, USN f ELECTE C-mNa&tva Cotmmanding Officer MAY Medical Rencrch Inolituir NAV Al. MI31)CAI. ItISP.AIICI ANDI)VlVllA)I'ME NT 4(A)MMANl O5-016

2 UNCLASSIFIV2-5ECUIAITY CLASSIFICATION OF THIS PAGE (IWhen,,De. Entered) REPORT DOCUMENTATION PAGE READ INSTRUCTIONS BEFORE COMPLETING FORM 1. REPORT NUMBER 2. GOVT ACCESSION No. 3. RECIPIENT'S CATALOG NUMBER NMRI )" / /7"7 4ý TITLE (and Su~btitle) 5. TYPE OF REPORT & PERIOD COVERED Effect of Alcohol on the Spreading Ability of Sodium Hypochlorite Endodontic Irrigant Medical Research Progress Report (Interim) 6. PERFORMING ORG. REPORT NUMBER 7. AU THOR(s) 8. CONTRACT OR GRANT NUMBER(s) / Walter T. Cunningham, John S. Cole, and Aram Y. Balekjian 9. PERFORMING ORGANIZATION NAME AND ADDRESS 10. PROGRAM ELEMENT, PROJECT, TASK AREA & WORK UNIT NUMBERS Naval Medical Research Institute Bethesda, Maryland MF Report No NTRO LJ11 FFICE NAME_ AND ADDRESS 12. REPORT QATE Nava VMedfa Research & Development Command September 1982 Naval Medical Command, National Capital Region 13. NUMBER OF PAGES Bethesda, Maryland MONITORING AGENCY NAME & AODRESS(it different from Controlling Office) IS. SECURITY CLASS. (ot!)his report) Bureau of Medicine and Surgery Department of the Navy Washington, DC s. DECLASSIFICATIONiDOWNGRADING SCHEDULE Unclassified 16. DISTRIBUTION STATEMENT (of this Report) Approved for public release and sale. Distribution unlimited. 17. DISTRIBUTION STATEMENT (of the abetract entered In block 20, If different from Report) II. SUPPLEMENTARY NOTES REPRINT: Oral Surgery, Oral Medicine, Oral Pathology 1982 September; 54(3): KEY WORDS (Continue on reverse side If neceewary and Identify by block nam.ber) Alcohol Sodium hypochlorite Endodontics Root canal 20, ABSTRACT (Continue on reveree side If neceeseay and identify by block nuumber) As a measure of the effect of ethanol on the ability of sodium hypochlorite to penetrate narrow openings such as root canals, mean distances of movement for combinations of these agents were mecasured in capillary tubes. The addition of ethanol as a surface tension depressant significantly increased the ability of the sodium hypochlorite endodontic irrigant to penetrate in vitro. A freshly mixed solution containing 30 percent ethanol is recommended. DO O 1473 EDITION O0 ' NOV 6, IS O.SOLETE UNCLASSIFIED SECURITY CLASSIFICATION OF THIS PAGE (When Data Intreod)

3 Reprinted from ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, St. Louis Vol. 54, No. 3, PP , September, 1982 (Printed in the U. S. A.) (Copyright 1982 by The C. V. Mosby Company) Effect of alcohol on the spreading ability of sodium hypochlorite endodontic irrigant Walter T. Cunningham, D.D.S., M.S., M.A., John S. Cole, III, Ph.D.,* and Aram Y. Balekjian, B.A., M.S., Bethesda, Md. DENTAl. RESEARCH BRANCH. CASUALTY CARE RESEARCH PROGRAM CENTER, NAVAL MEDICAL RESEARCH INSTITUTE. AND BIOLOGICAL CARCINOGENS BRANCH, DCCP. NATIONAL CANCER INSTITUTE As a measure of the effect of ethanol on the ability of sodium hypochlorite to penetrate narrow openings such as root canals, mean distances of movement for combinations of these agents were measured in capillary tubes. The addition of ethanol as a surface tension depressant significantly increased the ability of the sodium hypochlorite endodontic irrigant to penetrate in vitro. A freshly mixed solution containing 30 percent ethanol is recommended. Thorough d~bridement of the root canal space is considered to be essential for successful endodontic defined as the tension or strain upon the surface of a liquid in contact with another substance with which treatment. Many previous studies have shown sodi- it does not mix. Ethyl alcohol, an intermediate-level um hypochlorite to be an excellent endodontic irri- germicide, has a surface tension of only 24 dynes per gant exhibiting both antimicrobial and tissue-dissolv- centimeter, whereas water and most water-based ing properties. solutions have a surface tension of 71 to 79 dynes per However, it has also been shown that sodium centimeter. It is known that a mixture containing 95 hypochlorite is unable to penetrate and cleanse the percent water and 5 percent ethanol has a reduced narrow, confined portions of the root canal.' The surface tension of 54.9; increasing the percentage of studies of Senia, Marshall, and Rosen,' Salzgeber ethanol to 48 percent will further reduce this figure and Brilliant,' and Ram 4 have all demonstrated that to 28.0 dynes per centimeter. It has also been shown little or no spreading of the irrigant occurs in canals that ethyl alcohol will spread when placed on a that are smaller than file size 30 to 40. In an article dentin surface. 6 This is unlike saline solution and also describing the effective solvent action of sodium many endodontic medicaments which will form a hypochlorite, Rosenfeld, James, and Burch 5 stated lens on dentin, rather than exhibiting the spreading that "the major barrier to be overcome in the clinical phenomena. The purpose of this investigation is to use of this popular irrigant is its inability to penetrate evaluate the effect of ethanol on the spreading confined areas." property of the commonly used endodontic irrigant, Since sodium hypochlorite is a water-based solu- sodium hypochlorite. tion, it is possible that a surface tension depressant MATERIALS AND METHODS such as ethanol could be mixed with the hypochlorite in order to allow an increased fluid movement, or The movement of multiple samples of various spreading, of the irrigant drug. Surface tension is volume-to-volume mixtures of sodium hypochlorite, distilled water, and reagent-grade dehydrated ethanol were measured in glass tubes. The tubes were 25 This research wvi suppor!ea by the Naval Medical Rescarch and x micropipettes that were heat scaled at one end. The Development Command. Research Work Unit No. proportion of sodium hypochlorite in the solutions ZF The opinions and assertions contained herein are the private ones was maintained at 50 percent in every case, with the of the writers and are not to be construed as official or reflecting proportions of water and ethanol being variable. A the views of the Navy Department or the naval service at!arge. The mention of commercial products in this manuscript does not monostaltic pump (Buchler, Fort Lee, N. J.) was used to inject the test solutions uniformly into the constitute an endorsement or recommendation of these products by the Department of the Navy or the Department of Defense. simulated canals. This apparatus was used to ensure *Program Director, Biological Carcinogens Branch, DCCP, that the solutions were injected with a more uniform National Cancer Institute. pressure than could be achieved by hand injection. 333

4 334 Cunningham, Cole, and Balekjian Oral Surg. September Table I. Mean distances of movement for combina- Table II. Available chlorine determinations of sodium tions of sodium hypochlorite, water, and ethanol in hypochlorite, water, and alcohol sclutions glass tubes i Chlorine titer (7,1 -- ~Tilel" HO CHOl Distance (",in.).\o. (n/ (ml. rn 50% Ethanol ) (rnl.) (ram.) +_SD. 30% Ethanol " :G -.o * 2.23 I * 3.08 to * * /50 mixture; yet its useful working time was only -p < 0.0o. approximately 15 minutes. The solution containing 50 percent ethanol was almost totally depleted of Vernier calipers measured the distances moved by available chlorine in this same 15-minute time period and thus would not seem practical for clinical use. each combination of irrigant and surface tension The importance of these findings is that a part of depressant. From each group of ten samples, the the common endodontic armamentarium, alcohol, mean of the maximum movement within the tubes can be used as a surface tension depressant to aid the was calculated. The differences of the means were fluid movement of an irrigant into the narrow areas compared with Student's t test. of the root canal space. Even though the irrigant In order to determine the stability of alcohol- might be diluted by the ethanol, it still can act as a hypochlorite solutions, both 50 percent and 30 per- germicide and a debriding agent in those areas that cent alcohol mixtures were prepared. Samples were might otherwise not be penetrated and cleansed. The removed at 15 and 30 minutes for assay of available disinfection and debridement may even be enhanced chlorine content by iodometric titration.' by this improved wettability, 8 since a more intimate RESULTS contact of irrigant and dentin is provided. In addition, mechanical manipulation of narrow canals may Table I summarizes the mean distances that the be enhanced by the increased spreading of the combinations of sodium hypochlorite, water, and lubricant irrigant. Because chloroform may have a ethanol moved in vitro. Statistical comparisons harmful effect when injected through a large apical between groups demonstrated that a significant dif- foramen into the periapical tissues, the use of alcohol ference existed between all of the combinations that as a surface tension depressant is not recommended contained ethanol versus the one that contained no when the canal is enlarged sufficiently to be peneethanol. trated by standard irrigation procedures. As seen in Table II, the addition of alcohol to sodium hypochlorite reduces the residual available SUMMARY chlorine content, the effect being much greater and This study investigated the effect of ethanol on the more rapid with the higher proportion of alcohol. spreading property of the endodontic irrigant, sodi- DISCUSSION um hypochlorite. The distances moved by various mixtures of sodium hypochlorite, water, and ethanol A significant difference existed between each were measured in glass tubes. The mean distances of combination containing ethanol and those containing movement were significantly greater for those comno ethanol. The mean.distances that the irrigant binations containing ethanol. Thus, the addition of combinations moved were consistently and signifi- ethanol to act as a surface tension depressant signifcantly greater as the proportion of alcohol was icantly increased the ability of the irrigant to spread increased from 0 percent to 50 percent. The effect in vitro. can be easily demonstrated by placing equal volume We thank Ms. D. A. Dunham for her valuable editorial drops of the various mixtures on a glass slab and then and clerical assistance. We also wish to express our noting the area over which the drop spreads. appreciation to Drs. W. R. Cotton and D. W. Turner for "I he titration data point out that these solutions their critical review of the manuscript are not stable over time and must be mixed fresh in REFERENCES order to prevent the conversion of hypochlorite and ordetho ito chlroform. t he onversionatiof ontaining 1. Walton. R.: Histologic Evaluation of Different Methods of ethanol into chloroform. The combination containing Enlarging the Pulp Canal Space. J. Endod. 2: percent ethanol was much more stable than the 1976.

5 Volume 54 Effect of alcohol on spreading ability of sodium hypochlorite 335 Number 3 2. Senia. F. S.. Marshall, F. J.. and Rosen, S.: The Solvent 7. Furman. N. H.: Scott's Standard Methods of Chemical Action of Sodium Hypochlorite on Pulp Tissue of Extracted Analysis. ed.5. Lancaster D. Van Nostrand Co.. Inc. Teeth, ORS.N SLR(;. 31: , vol. I. p Saligeber. R. M., and Brilliant. J. D.: An In Vivo Evaluation 8. Coolidge, E. D.. and Kesel. R. G.: Endodontologv. ed. 2. ofthe Penetration of an Irrigating Solution in Root Canals. J. Philadelphia. 1956, Lea & Febiger. Publishers. pp Lndod. 3: Ram. Z.: Effectiveness of Root Canal Irrigation. ORAL SURG. 44: , Rosenfeld, E. F., James, G. A., and Burch. B. S.: Vital Pulp Reprint requests to: Tissue Response to Sodium Hypochlorite, J. Endod. 4: 140- Dr. Walter T. Cunningham 146, NavalM e archnni titut 6. Glantz., P.. and Hansson. L.: Wetting of Dentine by Some Naval Medical Research Institute Root Canal Medicaments. Odontol. Revy 23: Dental Research Branch Bethesda, Md F A o --- Ca. ees n r