Enterococcus, considered a normal commensal of intestinal tract, is fast emerging as a pathogen causing serious and life threatening hospital borne infections. This is attributed to acquisition of multi drug resistance and virulence factors of the organisms. The sequencing of Enterococcus faecalis has given a lot of insight into its genetic makeup. The E. faecalis strain V583, which has been sequenced, contains a total of 3182 open reading frames (ORFs) with 1760 of these showing similarity to known proteins and 221 of unknown functions. Strikingly unique to this genome is the fact that over 25% of the genome is made up of mobile and exogenously acquired DNA which includes a number of conjugative and composite transposons, a pathogenicity island, integrated plasmid genes and phage regions, and a high number of insertion sequence (IS) elements. This review addresses the genomic arrangement and the study of virulence factors that have occurred since the sequencing of the genome.

The present in-vitro study was undertaken to evaluate the antimicrobial efficacy of a traditional zincoxide eugenol based scaler(Tubliseal) with a iodoform incorporated zincoxide eugenol based sealer (Endotas FS), a calcium hydroxide based sealer (Apexit) and the epoxy resin based sealers (AH PLUS and PC Seal), against the micro organisms Enterococcus faecalis and Candida albicans. The method employed to test the antimicrobial efficacy was the Kirby-Bauer method (Agar Disc Diffusion). The sealers were mixed according to the manufacturer's instructions and 0.1 ml of each sealer was placed on the sterile paper discs. The diameter of the zones of inhibition was measured in millimeters with the help of an inhibition zone measuring scale and the values were recorded. The antimicrobial efficacy of an iodoform incorporated zincoxide eugenol based sealer, Endoflas FS against Enterococcus faecalis and Candida albicans was statistically superior to the rest of the test groups._Endotlas FS performed far better than even the controls being employed (Amoxycillin and Nystatin) respectively._Tubliseal, a zincoxide eugenol based seater also showed significant antimicrobial properties, but was statistically inferior to Endoflas FS Apexit, a calcium hydroxide based sealer did not show significant antimicrobial efficacy against both Enterococcus faecalis and Candida albicans. AH PLUS and RC seal, epoxy resin based sealers showed no antimicrobial properties whatsoever.

Aim/Objective: The aim of this study is to compare the antimicrobial efficacy of QMix ^TM 2 in 1, sodium hypochlorite (NaOCl), and chlorhexidine (CHX) against Enterococcus faecalis and Candida albicans. Materials and Methods: Eighty freshly extracted, single-rooted human mandibular premolar teeth were instrumented and autoclaved. Samples were divided into two groups of 40 teeth each based on the type of microorganism used. Group I was inoculated with E. faecalis and Group II with C. albicans and incubated for 3 days. Each group was subdivided into four subgroups based on the type of irrigant used. Group IA, IIA, 5.25% NaOCl; Group IB, IIB, 2% CHX; Group IC, IIC, QMix ^TM 2 in 1; and Group ID, IID, 0.9% saline (the control group). Ten microliters of the sample from each canal was taken and was placed on Brain Heart Infusion agar and Sabouraud dextrose agar. The plates were incubated at 37°C for 24 h and colony forming units (CFUs) that were grown were counted. Data was analyzed with analysis of variance (ANOVA) followed by post-hoc Games-Howell test. Results: The greatest antimicrobial effects were observed in samples treated with QMix ^TM 2 in 1 (P < 0.001). No statistical significant difference was found between 5.25% NaOCl and 2% CHX (P > 0.001) against E. faecalis and C. albicans. Conclusion: QMix ^TM 2 in 1 demonstrated significant antimicrobial efficacy against E. faecalis and C. albicans.

Aim: The aim of this investigation was to compare the efficacy of passive ultrasonic irrigation (PUI) with either 2.5% sodium hypochlorite (NaOCl) or saline, with that of conventional syringe irrigation on intraradicular Enterococcus faecalis biofilm. Materials and Methods: Biofilms of E. faecalis were established over 21 days in 80 single roots that had undergone biomechanical preparation followed by gamma radiation. Biofilms were treated for 1 min with 2.5% NaOCl/PUI (Group 1), 2.5% NaOCl (Group 2), sterile saline/PUI (Group 3), and sterile saline (Group 4). The positive control (n = 4) was used to confirm the presence of biofilm before various treatments. Additional four samples that served as a negative control were used to confirm the sterility of the samples. Biofilm eradication was evaluated by Colony Forming Unit (CFU) quantification and scanning electron microscopy (SEM). Results: The median of CFUs of S1 was significantly higher than that of S2 in all experimental groups. SEM examination showed a significant difference between the positive control and the experimental groups (P < 0.001), with the highest score of biofilm in the positive control group followed by Group 4 and both groups were not statistically significant from each other (P = 0.067). Following various treatments, the highest scores of biofilm were observed in the coronal third and the least were in the apical third. Conclusions: PUI did not increase the effectiveness of NaOCl irrigation on biofilm removal, however, PUI enhanced biofilm disturbance when used with saline. The least mean score of remaining biofilm was in the apical third of all treatment groups compared to other thirds.

Endodontic disease is a biofilm-mediated infection, and primary aim in the management of endodontic disease is the elimination of bacterial biofilm from the root canal system. The most common endodontic infection is caused by the surface-associated growth of microorganisms. It is important to apply the biofilm concept to endodontic microbiology to understand the pathogenic potential of the root canal microbiota as well as to form the basis for new approaches for disinfection. It is foremost to understand how the biofilm formed by root canal bacteria resists endodontic treatment measures. Bacterial etiology has been confirmed for common oral diseases such as caries and periodontal and endodontic infections. Bacteria causing these diseases are organized in biofilm structures, which are complex microbial communities composed of a great variety of bacteria with different ecological requirements and pathogenic potential. The biofilm community not only gives bacteria effective protection against the host's defense system but also makes them more resistant to a variety of disinfecting agents used as oral hygiene products or in the treatment of infections. Successful treatment of these diseases depends on biofilm removal as well as effective killing of biofilm bacteria. So, the fundamental to maintain oral health and prevent dental caries, gingivitis, and periodontitis is to control the oral biofilms. From these aspects, the formation of biofilms carries particular clinical significance because not only host defense mechanisms but also therapeutic efforts including chemical and mechanical antimicrobial treatment measures have the most difficult task of dealing with organisms that are gathered in a biofilm. The aim of this article was to review the mechanisms of biofilms' formation, their roles in pulpal and periapical pathosis, the different types of biofilms, the factors influencing biofilm formation, the mechanisms of their antimicrobial resistance, techniques to identify biofilms.

Introduction: Enterococcus faecalis has long been implicated in persistent root canal infections and therapy-resistant endodontic infections. It has also been associated with bacteremia, that is, infective endocarditis arising from certain invasive dental procedures. E. faecalis endocarditis antigen (efaA) has been identified as one of the principal virulence factors associated with infective endocarditis. Aim: To detect the presence of putative E. faecalis virulence factor, efaA in root canals of therapy-resistant endodontic infections using polymerase chain reaction (PCR) amplification. Materials and Methods: Samples were obtained from 32 patients (20-70 years) undergoing endodontic retreatment, which were incubated in prereduced thioglycollate broth and subcultured onto ethyl violet azide broth (EVA; selective medium for E. faecalis). Deoxyribonucleic acid (DNA) was extracted from the samples and analyzed for the endocarditis virulence factor efaA using PCR. Results: Among the positive E. faecalis samples, efaA gene was identified in 11 out of 15 samples. Conclusion: Our findings indicate that efaA, a potent E. faecalis virulence gene can be found in E. faecalis strains detected in root canals of therapy-resistant endodontic infections similar to reports for 'medical' strains.

Twenty five clinical isolates of high level gentamicin resistant Enterococcus faecalis were tested for their biofilm formation and pheromone responsiveness. The biofilm assay was carried out using microtiter plate method. Two isolates out of the 25 (8%) were high biofilm formers and 19 (76%) and four (16%) isolates were moderate and weak biofilm formers respectively. All the isolates responded to pheromones of E. faecalis FA2-2 strain. On addition of pheromone producing E. faecalis FA2-2 strain to these isolates, seven of 19 (37%) moderate biofilm formers developed into high biofilm formers. Similarly one of the 4 (25%) weak biofilm formers developed into high level biofilm former. Twelve (48%) of the 25 isolates were transconjugated by cross streak method using gentamicin as selective marker. This proves that the genetic factor for gentamicin resistance is present in the pheromone responsive plasmid. Among these twelve transaconjugants, seven isolates and one isolate were high biofilm formers on addition of E. faecalis FA2-2 and prior to its addition respectively. Out of the total 25 isolates, eight transconjugants for gentamicin resistance could turn to high biofilm formers on addition of the pheromone producing strain. All the isolates were resistant to more than two antibiotics tested. All the isolates were sensitive to vancomycin. The results indicate the significance of this nosocomial pathogen in biofilm formation and the role of pheromone responding clinical isolates of E. faecalis in spread of multidrug resistance genes.

Aim: The aim of this study is to evaluate the bactericidal effect of 908 nm diode laser in conjunction with various irrigation regimes in disinfection of apical third of root dentin. Materials and Methods: Sixty prepared teeth with single canals were contaminated with Enterococcus faecalis. The specimens were divided into 6 groups (n = 10): Group 1 and 3 and 5 were subjected to chemo-mechanical preparation using 5.25% sodium hypochlorite (NaOCl), 17% Ethylenediaminetetraacetic acid (EDTA); 1.3% NaOCl, MTAD (mixture of doxycycline, citric acid and a detergent (Tween 80); and, 8.5% saline, respectively followed by 908 nm diode laser irradiation; Group 2 and 4, followed the same procedure as Group1 and 3, however without laser irradiation; and, Group 6, rinsed with saline solution (control). Dentin shavings from apical third were analyzed for the presence of E. faecalis using culture method and Polymerase Chain reaction (PCR). Results: One-way Analysis of variance showed statistically significant differences between the laser irradiated groups, non irradiated groups and the control group. Conclusion: 908 nm diode used in conjunction with conventional chemomechanical techniques demonstrated a significant elimination of E. faecalis in the apical third of root dentin.

Objectives: To evaluate and compare the antibacterial efficiency of MTAD, Oxytetracycline, 5% NaOCl, and 2% chlorhexidine when used as root canal irrigants against Enterococcus faecalis. Materials and Methods: Fifty extracted human single rooted anterior teeth were selected. The decoronated sterilized root samples were infected with 10μl of 24 hours pure culture suspension of E. faecalis for 48 hours except for 10 teeth in negative control group (Group V). The test samples were divided into four groups (n = 10) as: Group I- 5% Sodium Hypochlorite, Group II- MTAD, Group III- Oxytetracycline and Group IV- 2% Chlorhexidine. The root canals were instrumented while using respective root canal irrigant solution. The bacterial cultures were taken from each root canal and colony forming units were counted on agar plates. The data was statistically analyzed. Results: It was observed that Group-III (Oxytetracycline) showed the maximum antibacterial efficacy against E. faecalis followed by Group II (MTAD), Group IV (2% Chlorhexidine), Group I (5% Sodium hypochlorite). Conclusion: Oxytetracycline has a great potential as a root canal irrigating agent because of its superior antimicrobial efficacy against E. faecalis, easy availability and cost effectiveness.