Comparative Evaluation of the Antimicrobial Effect of Mangosteen, Triphala, Chitosan, and 2% Chlorhexidine on Mono- and Dual-Species Biofilms of – and Candida albicans: An in Vitro Study

Objective: The purpose of this in vitro study was to compare the antimicrobial effectiveness of 2% chlorhexidine gel, 0.5% chitosan, ethanol extract of mangosteen pericarp, and Triphala used as intracanal medicaments against Enterococcus faecalis and Candida albicans in mono- and dual-species biofilms. Methods: Bioactive components in the ethanol extract of mangosteen pericarp and Triphala were evaluated by gas chromatography-mass spectrometry (GCMS). Quantitative assessment of the biofilm formations of E. faecalis and C. albicans and as a dual-species in the presence of test medicaments was carried out using a crystal violet (CV) assay in a microtiter plate. Following this, 246 single-rooted premolar teeth were collected, and root specimens were prepared. C. albicans and E. faecalis mono- and dual-species biofilms were grown in the root specimens. At the end of 21 days, the samples were divided into five groups and subjected to different types of medicaments: Control group- distilled water; Chlorhexidine group- 2% chlorhexidine gel; Chitosan group- 0.5% chitosan; Mangosteen group- ethanol extract of mangosteen pericarp; and Triphala group- ethanol extract of Triphala. Colony-forming units (CFUs) were assessed on the first and fifth day after medicament placement. Results: Microbial population reduction was measured by one-way analysis of variance, followed by post-hoc Tukey’s multiple comparison test (P<0.05). Chlorhexidine showed maximum log reduction in CFUs of microorganisms, followed by chitosan, which showed a similar log reduction (P>0.05) for both mono- and dual-species biofilms. However, in the mangosteen and Triphala extract groups, the CFU/mL for dual-species on both days did not have a significant reduction in count (P<0.05) when compared to chlorhexidine and chitosan. Conclusion: Chlorhexidine showed maximum antimicrobial activity, followed by chitosan, on both mono- and dual-species biofilms. Mangosteen and Triphala had good antimicrobial action on the mono-species biofilm.