Antimicrobial Therapeutic Strategies for Enterococcus faecalis In Dental Infections - Past, Present and Future

Enterococcus faecalis is a common opportunistic pathogen that can infect various tissues in the human body and in particular, the oral cavity. It has been implicated in periodontal disease, oral mucosal lesions in immunocompromised patients, peri-implantitis, peri-radicular abscesses, and root canal infections. They are also most prevalent in secondary endodontic infections and are recognized as treatment-resistant bacteria in the root canal. Virulence factors help in this pathogenicity as some factors aid its adherence to the surface. It has become a research focus in recent times for its resistance to various antibiotics like vancomycin and so, the search for alternative therapeutic approaches has also evolved. Although various chemical irrigants such as sodium hypochlorite (NaOCl), chlorhexidine (CHX), iodine potassium iodide (IKI), calcium hydroxide (Ca(OH)2) and chlorine dioxide (ClO2) have been used for years, the use of plant extracts and essential oils have attracted the researchers to explore their activity against various dental pathogens like E. faecalis. Recently, it has been found that the phages are more effective in treating biofilm than antibiotics and it has also been observed that they are effective when used in combination with antibiotics. In this review, we have presented various treatment strategies that have been in use for treating dental infections and also discussed future therapeutic approaches, which, may help unfold promising novel strategies.