Sequential Herbal Irrigation Safe and Biocompatible Alternative in Pediatric Endodontics: Study

A randomized controlled trial published in the Journal of Indian Society of Pedodontics and Preventive Dentistry (July–September 2025 issue) by Shrikant Bhujangrao Kendre, Anuja U. Bhatane, Mahesh Vilasrao Dadpe, Yogesh Jagannath Kale, and Prasanna Trambakrao Dahake has reported that sequential herbal irrigation may offer a safe and effective alternative to conventional irrigants in the endodontic treatment of primary teeth. The authors point out that while sodium hypochlorite, ethylenediaminetetraacetic acid, and chlorhexidine are commonly used to disinfect root canals, they can pose risks such as cytotoxicity, unpleasant taste, and tissue irritation—factors of particular concern in young children. The study found that a herbal protocol combining Salvadora persica (Miswak), Azadirachta indica (Neem), tea tree oil, and phytic acid achieved antimicrobial efficacy comparable to chemical irrigants, with the added advantages of biocompatibility and safety.

The trial involved 15 children aged 4 to 8 years with bilateral primary molars indicated for pulpectomy, making it one of the first controlled comparisons of sequential herbal and conventional irrigants in pediatric patients. Both treatment groups showed significant microbial reduction, but herbal irrigation demonstrated slightly greater activity against Enterococcus faecalis, a key bacterium implicated in endodontic failure. Although the difference in efficacy against Prevotella intermedia was not statistically significant, the overall results underscored that the herbal regimen could match or even surpass chemical alternatives in effectiveness. By integrating multiple plant-based agents with known antimicrobial and chelating properties, the sequential protocol leveraged the synergistic action of natural compounds to disinfect root canals while minimizing potential adverse effects.

According to the authors, the findings highlight the promise of herbal irrigants in pediatric dentistry, where tolerance, safety, and biological compatibility are as important as antimicrobial efficacy. The ability to achieve reliable bacterial reduction without exposing children to harsh chemicals makes sequential herbal irrigation a potential game changer in clinical practice. The researchers recommend further trials on larger patient populations to confirm these outcomes and to standardize protocols for herbal use. Still, the study marks an important step in advancing natural, biocompatible strategies in pediatric endodontics.

Reference:

Kendre SB, Bhatane AU, Dadpe MV, Kale YJ, Dahake PT. Comparative evaluation of antibacterial efficacy of sequential herbal irrigation with conventional irrigation in endodontic therapy of primary teeth: A randomized controlled trial. J Indian Soc Pedod Prev Dent. 2025;43(3):410–417. doi:10.4103/jisppd.jisppd_253_25

Keywords: Sequential herbal irrigation, pediatric endodontics, antimicrobial efficacy, biocompatibility, cytotoxicity, Shrikant Bhujangrao Kendre, Journal of Indian Society of Pedodontics and Preventive Dentistry