Sea buckthorn in endodontics: A comprehensive review of Its antimicrobial efficacy against Enterococcus faecalis in root canal infections

AIM. Enterococcus faecalis is a gram-positive facultative anaerobe commonly known as the primary pathogen implicated in persistent and secondary endodontic infections, due to its exceptional capacity to invade dentinal tubules, form resistant biofilms and survive in nutritionally adverse alkaline environments. Although effective, conventional chemical irrigants like sodium hypochlorite and chlorhexidine have been found to cause cytotoxicity and other unwanted effects. Sea buckthorn (Hippophae rhamnoides L.) is a medicinal plant that has shown promise as a natural antimicrobial agent due to its richness in flavonoids, polyphenols, carotenoids and unsaturated fatty acids. The purpose of this review is to summarize and examine existing evidence on the antimicrobial efficacy, mechanisms of action, and clinical potential of sea buckthorn against E. faecalis in the context of root canal infections.

MATERIALS AND METHODS. The literature review was conducted thoroughly by using the PubMed, Embase and Cochrane Library databases. The review incorporated studies in English that involved phytochemical, microbiological, in vitro, and in vivo studies that were relevant to the study involving the use of sea buckthornderived agents when conducting dentistry and endodontics research.

RESULTS. Extracts of sea buckthorn exhibit broad-spectrum antimicrobial activity that can be ascribed to bioactive compounds, such as quercetin, kaempferol, isorhamnetin, palmitoleic acid and ascorbic acid. Disruption of bacterial cell membranes, inhibition of biofilm formation, suppression of acid production, and modulation of host inflammatory responses are all reported antibacterial mechanisms. Aqueous and hydroalcoholic leaf extracts have demonstrated growth-inhibitory action against E. faecalis, whilst, pulp oilbased preparations have demonstrated anti-biofilm activity against a variety of oral pathogens. Comparative studies indicate similar, and in certain cases better, efficacy compared with chlorhexidine, and much better biocompatibility.

 CONCLUSIONS. Sea buckthorn is a biocompatible, multifunctional adjunct that can be used as an endodontic irrigant or intracanal medicament. Nonetheless, before it can be adopted into routine clinical practice, standardization of extraction techniques, optimal concentrations, and optimally designed randomized clinical trials are required.

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