Comparative evaluation of antibacterial efficacy of sequential herbal irrigation with conventional irrigation in endodontic therapy of primary teeth: A randomized controlled trial.

BACKGROUND: Successful endodontic therapy in primary teeth relies on effective microbial control. Although conventional irrigants are effective, they pose risks such as cytotoxicity, unpleasant taste, and tissue irritation. Herbal alternatives offer a safer, biocompatible option, especially suitable for children. AIMS: To evaluate and compare the antimicrobial efficacy of a sequential herbal irrigation protocol with a conventional irrigation protocol in the endodontic treatment of primary teeth. MATERIALS AND METHODS: It is a split-mouth, double-blind, and randomized controlled trial that included 15 pediatric patients aged 4-8 years with bilateral primary molars indicated for pulpectomy. Group I received conventional irrigation with 3% sodium hypochlorite, 17% ethylenediaminetetraacetic acid, and 2% chlorhexidine. Group II underwent sequential herbal irrigation using ethanolic extracts of 12.5% Salvadora persica (Miswak), 20% Azadirachta indica (Neem), 2% tea tree oil, and 10% phytic acid. Pre and postirrigation microbial samples were collected and cultured to quantify Enterococcus faecalis and Prevotella intermedia. Statistical analysis used paired t-tests for intragroup comparisons and one-way analysis of variance for intergroup differences, with significance set at P < 0.05. RESULTS: Both groups showed significant microbial reduction (P < 0.0001). Group I had 90.54% and 87.6% reductions in E. faecalis and P. intermedia, respectively, while Group II achieved 92.2% and 90.54%. Herbal irrigation showed significantly greater E. faecalis reduction (P = 0.025), but P. intermedia reduction was not significant (P = 0.384). CONCLUSIONS: The sequential herbal irrigation protocol showed comparable antimicrobial efficacy to conventional agents, with added benefits of safety, biocompatibility, and reduced cytotoxicity, making it a promising natural alternative in pediatric endodontics.