Hello!

May I suggest the paper below please?

J Endod. 2012 Sep;38(9):1257-60.

The effect of surfactant on the dissolution of porcine pulpal tissue by sodium hypochlorite solutions.

Clarkson RM, Kidd B, Evans GE, Moule AJ.

Thanks for your answer. I know very well this paper. Adding surfactant to NaOCl is my research topic and i would like to collect different opinions and arguments about it. I'm really convinced that the use of surfactants improves the spreading of endodontic irrigants. There are likely other advantages to use it as the effect on dissolution pulpal tissue. Having said that, this topic is a matter of debate and very controversial. Basically, there are many authors in favour of surfactants and other against...arguments in order to justify the two points of view are welcome.

Which class of surfactant? Because you have to bear in mind each class of surfactant (cationic, anionic, or nonionic) has a characteristic action. In other words, not all types of surfactants do same.

Would love to see a study comparing the use of surfactants compared to simply energising the NaOCl.

I use tween-80 surfactant, but mixed with 40% CA. Similar to MTAD but without antibiotic (but tertacycline is a nonsense here). So it is MAD ;) Cleg or Dunavant tested NaOCl mixed with surfactant on biofilms. One of the findings was that surfactant didn't improve anything. There's no EBD for surfactants. Why i use it? I use it because i mostly do retreatments. During reendo i often use eucaliptol or other solvents. CA with surfactant helps me to remove fatty debris. Together with NaOCl they create bubbles that can evacuate debris efficiently. So no EBD here, but superstition ;) Maybe if u can, prove that or idea is good ;) Good luck.

There is already such a product in the market produced by Vista from USA. It was developed by Happasalo from Vancouber Canada who wrote an article about it and it seems that this combination is very potent as bacteriocidal agent.

I would agree, but under one condition: solution must be fresh, because NaOCl is not stable. I'm affraid that Vista NaOCl solution is not fresh here in Europe (shipping etc.).

Be careful. Depending on the nature of the surfactant and pH, you can get reactions with formation of toxic products. For example alpha olefin sulfonate (AOS) reacts with hypochlorite to form unsaturated sultones that are highly allergenic:

Roberts DW, Williams DL, Bethell D. 2007. Electrophilic Reactions of Skin Sensitizing Sultones. Chem. Res. Toxicol. 20: 61-71.

Roberts DW, Williams DL Sultones as By–Products in Anionic Surfactants. Tenside Detergents 20, 109 –11 (1983).

In my opinion, this issue would bring more interest among researchers. Different concentrations/applications/interactions/antimicrobial effect/cytotoxicity and etc......

- I believe that the ability of this combination to increase the occasion for hypochlorite accident should also be questioned.

I agrre with Hany Ahmed too

Thought provoking!!

I think the factors to be considered and studied are

1. Chemistry between Sodium hypochlorite and surfactant including bye products

2. Antimicrobial efficacy of the combination

3. Pulp dissolution ability

4. Altered toxicity and allergenic tendency

5. Other possible side effects.

Many times we want to incorporate benefits of individual components into a combination, but ultimately chemical reaction affects the properties of the final product. One property would be improved and other additional benefit would be missed. Hence all the aspects must be studied.

I totaly agree with Kanthti Sirisha. In the past I was involved in developing chemotheraputic agent for irrigation and medication which was based on cationic surfactant of the quartenary amonium group in the name of bis dequalinium acetate (BDA). It had all the good virtues we expect from a cfemotheraputic agent beside its ability to disolve organic matter. It had better qualities than bezalkonium chloride (BC) as it was active in presance of organic material unlike BC. The product was named Solvidont and was manufactured by De Trey it was discontinued when Dentsply bought them. The experiments to engage BDA into NaOCl was not successful as it always caused precipitation. I did not try another cationic surfactant that might work differently which is bis dequalinum chloride and I suggest you will try it.

This is the litrature I wrote about BDA and there are others by other reaserchers

1 A.Y. Kaufman and E. Henig

The microbiologic approach in endodontics

Oral Surgery, Oral Medicine, Oral Pathology Vol. 42, (pp. 810-816) 1976

2. A.Y. Kaufman, J. Arwas, B. Heling and I. Gedalia

Acid solubility of dentin pretreated with EDTA, “Salvizol” and sodium lauryl sulfate

Journal of Dental Research Vol. 56, (p. 1232) 1977

3. L. Spangberg, A.Y. Kaufman, E. Spangberg and M. Rutberg

“Salvizol” as an intracanal antiseptic for endodontic use

Oral Surgery, Oral Medicine, Oral Pathology Vol. 46, (pp.427-432) 1978

4. A.Y. Kaufman, I. Binderman, M. Tal, I. Gedalia and G. Peretz

New chemotherapeutic agent for root canal treatment: A preliminary election microscopic study on in vivo and in vitro endodontically treated teeth

Oral Surgery, Oral Medicine, Oral Pathology Vol. 46, (pp. 283-295) 1978

5. A.Y. Kaufman

The use of dequalinium acetate as a disinfectant and chemotherapeutic agent in endodontics

Oral Surgery, Oral Medicine, Oral Pathology Vol. 51 (4), (pp. 434-441) 1981

6. A.Y. Kaufman

Solvidont – a new chemotherapeutic and bacteriocidal agent for endodontic use. Part I

a) Quintessence International Vol. 14, 1983 (pp. 71-79)

b) Quintessence International (Italian edition) Vol. 1 (12), (pp. 1169-1177) 1985

7. A.Y. Kaufman

Solvidont – a new chemotherapeutic and bacteriocidal agent for endodontic use. Part II

a) Quintessence International Vol. 14, (pp. 235-244) 1983

b) Quintessence International (Italian edition) Vol. 2 (1), (pp. 75-84) 1986

8. A.Y. Kaufman and A. Zach

Quantitative evaluation of the influence of bis-dequalinium acetate and sodium hypochlorite on human dentition

Oral Surgery, Oral Medicine, Oral Pathology Vol. 53 (3), (pp.524-526) 1983

9. A.Y. Kaufman, I. Binderman and N. Fine

The influence of bis-dequalinium acetate on bone regeneration induced by grafts of combined inorganic heterologous and autologous bone marrow

Oral Surgery, Oral Medicine, Oral Pathology Vol. 57 (3), (pp. 315-319) 1984

10. A.Y. Kaufman and I. Greenberg

Comparative study of the configuration and the cleanliness level of root canals prepared with the aid of sodium hypochlorite and bis-dequalinium acetate solutions

Oral Surgery, Oral Medicine, Oral Pathology Vol. 62 (2), (pp. 191-197) 1986

11. L. Spangberg, E.A. Pascon, A.Y. Kaufman and K. Safavi

Tissue irritating properties of BDA solutions for endodontic use

Journal of Endodontics Vol. 14 (2), (pp. 88-97) 1988

12. L. Spangberg, K. Safavi, A.Y. Kaufman and E.A. Pascon

Antimicrobial and toxic effect in vitro of bisdequalinium-acetate solution for endodontic use

Journal of Endodontics Vol. 14 (4), (pp. 175-178) 1988

Nice discussion. Frederic Bukiet - i know that NaOCl solutions are buffered and stabilized, but i read few articles about the efficiency of fresh and old NaOCl solutions. After 3 months u don't have 5%, even if it were 6% at the day of production. Maybe they fixed it in Vista. I don't have enough data about their product. My main reflection is that: we always seek for something better, but we still use NaOCl (from 19th century till now). We try to improve it, but we can't find substitute. I'm wondering also about influence of ultrasonic activation on solution's intergrity. David Roberts gave us another point of view. We should consider unknown interactions.

Frédéric Bukiet of course the non-ionic Triton-X surfactant does not work well as the cationic due to the low polarity of the former. So you have to use only the cationic (such as benzalkonium chloride). This because you cannot use anionic surfactant which can react chemically with NaOCl then you will lose the activity of the latter reagent.

Thank you so much rabah Khalil. I think the mix of researchers of different specialities deeply contributes to improve our works. Your skills in physical and chemistry is clearly an exemple of contribution. Maybe it is the main and usefull advantage of Research gate.

very informative discussion adding surfactant to NaOCL will lower the surface tension but may affect the rate of tissue dissolution by NaOCL. if at all surfactant is to be added yes i agreeit has to be cationic

i think the temperature of sodium hypochlorite is more important than lowering the surface tension