<i>Candida albicans</i> Biofilm Heterogeneity and Tolerance of Clinical Isolates: Implications for Secondary Endodontic Infections

• Main Authors: Om Alkhir Alshanta, Suror Shaban, Christopher J Nile, William McLean, Gordon Ramage
• Format: Article
• Language: English
• Published: MDPI AG 2019-10-01
• Series: Antibiotics
• Subjects: biofilm; <i>candida albicans</i>; edta; naocl; tolerance
• Online Access: https://www.mdpi.com/2079-6382/8/4/204

Aim: Endodontic infections are caused by the invasion of various microorganisms into the root canal system. <i>Candida albicans</i> is a biofilm forming yeast and the most prevalent eukaryotic microorganism in endodontic infections. In this study we investigated the ability of <i>C. albicans</i> to tolerate treatment with standard endodontic irrigants NaOCl (sodium hypochlorite), ethylenediaminetetraacetic acid (EDTA) and a combination thereof. We hypothesized that biofilm formed from a panel of clinical isolates differentially tolerate disinfectant regimens, and this may have implications for secondary endodontic infections. Methodology: Mature <i>C. albicans</i> biofilms were formed from 30 laboratory and oral clinical isolates and treated with either 3% NaOCl, 17% EDTA or a sequential treatment of 3% NaOCl followed by 17% EDTA for 5 min. Biofilms were then washed, media replenished and cells reincubated for an additional 24, 48 and 72 h at 37 &#176;C. Regrowth was quantified using metabolic reduction, electrical impedance, biofilm biomass and microscopy at 0, 24, 48 and 72 h. Results: Microscopic analysis and viability readings revealed a significant initial killing effect by NaOCl, followed by a time dependent significant regrowth of <i>C. albicans</i>, but with inter-strain variability. In contrast to NaOCl, there was a continuous reduction in viability after EDTA treatment. Moreover, EDTA significantly inhibited regrowth after NaOCl treatment, though viable cells were still observed. Conclusions: Our results indicate that different <i>C. albicans</i> biofilm phenotypes grown in a non-complex surface topography have the potential to differentially tolerate standard endodontic irrigation protocols. This is the first study to report a strain dependent impact on efficacy of endodontic irrigants. Its suggested that within the complex topography of the root canal, a more difficult antimicrobial challenge, that existing endodontic irrigant regimens permit cells to regrow and drive secondary infections.