sodium-hypochlorite and chloramine

Sodium hypochlorite, a gold standard for irrigation in endodontics, has disadvantages like toxicity and root dentin weakening. Alternatives derived from natural products are being explored.. This systematic review was done to understand the clinical benefits of natural irrigants when compared with a standard irrigant, sodium hypochlorite.. This systematic review was registered with PROSPERO (2018 CRD42018112837) METHODS AND MATERIAL: This review was done in conformation to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA 2020) statement. In vivo studies using at least one natural irrigant and sodium hypochlorite (NaOCl) were included. Studies using them as medicaments were excluded. PubMed, Cochrane and SCOPUS were searched. RevMan tool for Risk of Bias 2 (RoB 2) and risk-of-bias tool to assess non-randomized studies of interventions (ROBINS-I) were used. GRADEpro was used to assess certainty of evidence.. Ten articles (6 RCTs and 4 clinical studies) on approximately 442 patients were included. Seven natural irrigants were evaluated clinically. Due to the heterogeneity, meta-analysis could not be conducted. Antimicrobial efficacy was found to be similar for castor oil, neem, garlic-lemon, noni, papaine and NaOCl. Neem, papaine-chloramine, neem-NaOCl and neem-CHX were superior, while propolis, miswak and garlic were inferior to NaOCl. Post-operative pain was less for neem. There was no significant difference between papaine-chloramine, garlic extract and sodium hypochlorite in clinical/radiographic success.. The studied natural irrigants are not more efficacious than NaOCl. At the moment, they cannot replace NaOCl routinely and may only substitute in select cases.

Topics: Anti-Infective Agents; Chloramines; Dental Pulp Cavity; Humans; Root Canal Irrigants; Sodium Hypochlorite

Nitrosamines are a class of emerging disinfection by-products (DBPs), which are mainly formed when water is treated by chloramination. Nitrosamines are highly carcinogenic and are hence a major concern for drinking water supplies. Although dissolved organic nitrogen (DON) compounds such as dimethylamine (DMA) have been recognized as important precursors of nitrosamines, many of them have not been identified, especially those used in consumer products. In this study, nine representative nitrogenous organic compounds with different DON characteristics and structures were selected to react with free chlorine, chlorine dioxide and monochloramine, respectively, for their DBP formation characteristics (nitrosamines, trihalomethanes (THMs) and haloacetic acids (HAAs)). It was found that in addition to DMA, benzyldimethyltetradecylamine (benzalkonium chloride, BKC) and 3-(N,N-dimethyloctyl-ammonio)propanesulfonate (3-N,N-DAPSIS) inner salt were potent precursors for carbonated DBPs (C-DBPs) and nitrogenated DBPs (N-DBPs). The DBP formation potential (DBPFP) tests showed that 1 mM of BKC formed more than 2 × 10(5) ng/L of N-nitrosodimethylamine (NDMA) when treated with monochloramine and high levels of C-DBPs (2713 ± 145 μg/L of THMs and 356 ± 5 μg/L of HAAs) when treated with chlorine. 3-N,N-DAPSIS was a less potent DBP precursor: 1 mM of 3-N,N-DAPSIS generated 1155 ± 7 ng/L of NDMA, 1351 ± 66 μg/L of THMs and 188 ± 1 μg/L of HAAs. DMA, 3-N,N-DAPSIS and BKC were examined for their DBPFPs at various pH and temperatures to determine the impact of pH and reaction temperature on DBP yields and their formation mechanisms. The results showed that DBP yields apparently increased with rising temperature. However, no consistent correlations were observed between DBPs yields and pH. Bromide shifted the DBP species into brominated DBPs, and this phenomenon was more apparent when BKC was treated with chloramine.

Topics: Bromides; Carbon; Chloramines; Chlorine Compounds; Disinfection; Hydrogen-Ion Concentration; Nitrogen; Nitrogen Compounds; Organic Chemicals; Oxides; Sodium Hypochlorite; Solubility; Temperature

Topics: Antioxidants; Aryldialkylphosphatase; Ascorbic Acid; Carboxylic Ester Hydrolases; Chloramines; Humans; Lipoproteins, HDL; Oxidants; Oxidation-Reduction; Phosphoric Triester Hydrolases; Sodium Hypochlorite

Studies were conducted to compare the effect of sodium hypochlorite (SH) versus monochloramine (MON) on bacterial populations associated with broiler chicken carcasses. In study 1, nominal populations (6.5 to 7.5 log CFU) of Escherichia coli, Listeria monocytogenes, Pseudomonas fluorescens, Salmonella serovars, Shewanella putrefaciens, and Staphylococcus aureus were exposed to sterilized chiller water (controls) or sterilized chiller water containing 50 ppm SH or MON. SH at 50 ppm eliminated all (6.5 to 7.5 log CFU) viable E. coli, L. monocytogenes, and Salmonella serovars; 1.2 log CFU of P. fluorescens; and 5.5 log CFU of S. putrefaciens. MON eliminated all (6.5 to 7.5 log CFU) viable E. coli, L. monocytogenes, S. putrefaciens, and Salmonella serovars and 4.2 log CFU of P. fluorescens. In study 2, chicken carcasses were inoculated with P. fluorescens or nalidixic acid-resistant Salmonella serovars or were temperature abused at 25 degrees C for 2 h to increase the populations of naturally occurring E. coli. The groups of Salmonella serovar-inoculated or temperature-abused E. coli carcasses were immersed separately in pilot-scale poultry chillers and exposed to tap water (controls) or tap water containing 20 ppm SH or 20 ppm MON for 1 h. The P. fluorescens-inoculated group was immersed in pilot-scale poultry chillers and exposed to tap water (controls) or tap water containing 50 ppm SH or 50 ppm MON for 1 h. Carcasses exposed to the SH treatment had nominal increases (0.22 log CFU) in E. coli counts compared with controls, whereas exposure to MON resulted in a 0.89-log reduction. Similarly, average nalidixic acid-resistant Salmonella serovar counts increased nominally by 34% (41 to 55 CFU/ml) compared with controls on carcasses exposed to SH, whereas exposure to MON resulted in an average nominal decrease of 80% (41 to 8 CFU/ml). P. fluorescens decreased by 0.64 log CFU on carcasses exposed to SH and decreased by 0.87 log CFU on carcasses exposed to MON. In study 3, SH or MON was applied to the chiller in a commercial poultry processing facility. E. coli counts (for carcass halves emerging from both saddle and front-half chillers) and Salmonella prevalence were evaluated. Data from carcasses exposed to SH during an 84-day historical (Hist) and a 9-day prepilot (Pre) period were evaluated. Other carcasses were exposed to MON and tested during a 27-day period (Test). E. coli counts for samples collected from the saddle chiller were 25.7, 25.2, and 8.6 CFU/ml

Topics: Animals; Bacteria; Chickens; Chloramines; Colony Count, Microbial; Disinfectants; Disinfection; Dose-Response Relationship, Drug; Food Contamination; Food Handling; Food Microbiology; Sodium Hypochlorite; Temperature; Time Factors

The formation of the potent carcinogen, N-nitrosodimethylamine (NDMA), during chlorine disinfection has caused significant concern among drinking water and wastewater recycling utilities practicing intentional or unintentional chloramination. Previous research modeled NDMA formation as arising from a reaction between monochloramine and organic nitrogen precursors, such as dimethylamine, via an unsymmetrical dimethylhydrazine (UDMH) intermediate. Contrary to the importance of monochloramine indicated by previous studies, hypochlorite formed an order of magnitude more NDMA than monochloramine when applied to a secondary municipal wastewater effluent containing excess ammonia. Experiments involving variation of the order that each reagent (i.e., hypochlorite, ammonium chloride, and dimethylamine) was added to solution suggest two factors that may be more important for NDMA formation than the presence of monochloramine: (i) the chlorination state of organic nitrogen precursors and (ii) the partial formation of dichloramine. Although dichloramine formation was most influenced by the pH conditions under which inorganic chloramine formation was performed, mixing effects related to the order of reagent addition may be important at full-scale plants. Chloramination strategies are suggested that may reduce NDMA formation by nearly an order of magnitude.

Topics: Ammonium Chloride; Carcinogens; Chloramines; Chlorine; Dimethylamines; Hydrogen-Ion Concentration; Indicators and Reagents; Nitroso Compounds; Sewage; Sodium Hypochlorite; Water Purification

In chemo-mechanical caries removal procedures, chloramines are typically used for chemical softening of carious dentin. However, the specific effect of chloramines to be compared to sodium hypochlorite has not been sufficiently clarified. In present study, the effect of chloramines used in the Carisolv-system on carious dentin mechanical properties and morphology were investigated, using Vickers hardness test and scanning electron microscopy (SEM). Sections of permanent teeth with dentin caries were treated with chloramines, prepared by mixing amino acids (glutamic acid, lysine, and leucine) with sodium hypochlorite or with sodium hypochlorite alone or with purified water. There was a tendency that the application of the sodium hypochlorite solution softened the sound dentin and/or inner layer of carious dentin more than the application of the chloramines solution did. In SEM observations, the application of chloramines resulted in opening dentinal tubules in the outer layer of carious dentin: Occluded dentinal tubules were seen after sodium hypochlorite application. There is a possibility that the amino acids in the Carisolv-system decrease the aggressive effect of sodium hypochlorite on sound dentin and/or inner layer of carious dentin and also would enhance the disrupting effect on degenerated collagen in carious dentin outer layer.

Topics: Cariostatic Agents; Chloramines; Dental Caries; Dental Cavity Preparation; Dentin; Drug Interactions; Glutamic Acid; Hardness; Humans; Leucine; Lysine; Microscopy, Electron, Scanning; Sodium Hypochlorite

Natural-killer (NK) cell-derived malignant tumors, such as angiocentric lymphoma, is often resistant to various chemotherapeutic agents and follows an aggressive clinical course. We report the effects of physiological oxidants (hydrogen peroxide, H2O2; sodium hypochlorite, NaOCl and monochloramine, NH2Cl) on the cell growth and cell death in a multidrug-resistant NK tumor cell line, NK-YS. Among the oxidants tested, NH2Cl was most cytotoxic, in which more than 90% of the cells died at 150 nmol/1 x 10(6) cells. H2O2 was less cytotoxic, whereas NaOCl showed no significant cell death at this dose. The cell death induced by NH2Cl was accompanied by DNA cleavage and caspase activation, which suggested apoptosis. In addition, lower dose of NH2Cl (70 nmol/1 x 10(6) cells) retarded cell growth and inhibited the cell cycle transition from G1 to S. This cell cycle arrest accompanied a decrease in the phosphorylation of retinoblastoma tumor suppressor protein at serine 795. These observations suggest that NH2Cl may induce apoptotic cell death and growth arrest in multidrug-resistant NK cell tumors.

Topics: Apoptosis; Blotting, Western; Caspases; Cell Cycle; Cell Death; Cell Division; Cell Line, Tumor; Cell Survival; Chloramines; DNA; Dose-Response Relationship, Drug; Drug Resistance, Multiple; Drug Resistance, Neoplasm; Enzyme Activation; Humans; Hydrogen Peroxide; Interleukin-2; Killer Cells, Natural; Oxidants; Phosphorylation; Receptors, Interleukin-2; Recombinant Proteins; Retinoblastoma Protein; Serine; Signal Transduction; Sodium Hypochlorite; Time Factors; Tyrosine

It has been known for years that mixing household cleaning products can be hazardous. Nonetheless, from time to time, episodes of pneumonitis from such mixing occur. Although symptoms range from minor upper respiratory irritation to adult respiratory distress syndrome, deaths are very rare. We present the case of a woman with an undiagnosed oligodendroglioma who mixed bleach and ammonia (resulting in the formation of chloramine gas), and died while cleaning her bathroom. To our knowledge, this is the first such death reported from chloramine gas intoxication.

Topics: Adult; Ammonia; Chloramines; Drug Combinations; Fatal Outcome; Female; Forensic Medicine; Humans; Oligodendroglioma; Sodium Hypochlorite

Topics: Airway Obstruction; Ammonia; Chloramines; Female; Household Products; Humans; Middle Aged; Pneumonia; Sodium Hypochlorite; Tracheostomy

Monochloramine (NH2Cl) is known to be one of the virulence factors in Helicobacter pylori-associated gastric mucosal injury. The present study was designed to examine NH2Cl-evoked DNA fragmentation in the gastric epithelial cell line MKN45. NH2Cl was produced by mixing NH3 with sodium hypochlorite (NaClO). MKN45 cells were exposed to NH2Cl, NH3, or NaClO in Hanks' balanced salt solution. DNA cleavage was evaluated quantitatively by photometeric enzyme immunoassay for the in vitro determination of cytoplasmic mono- and oligonucleosomes. Damage to the plasma membrane was assessed by measuring the activity of lactate dehydrogenase in the supernatants. Separately, DNA ladder formation was performed to confirm the incidence of DNA fragmentation. NH2Cl (0.001-0.01 mM) significantly increased the cytoplasmic mono- and oligonucleosomes, suggesting the incidence of DNA cleavage. The DNA ladder was clearly evoked by NH2Cl. NH2Cl induced a DNA fragmentation, one of the important aspects in apoptosis, in the gastric cell line MKN45.

Topics: Adenocarcinoma; Ammonia; Chloramines; DNA Fragmentation; Gastric Mucosa; Helicobacter pylori; Humans; L-Lactate Dehydrogenase; Sodium Hypochlorite; Stomach Neoplasms; Taurine; Tumor Cells, Cultured; Virulence

The effects of cytotoxic monochloramine on the development of gastric cancers induced by N-methyl-N'-nitro-N-nitrosoguanidine were investigated in Wistar rats. After oral administration of drinking water containing the carcinogen and regular chow pellets for 25 weeks, rats received regular chow pellets or chow pellets containing 20% ammonium acetate, and normal tap water or water containing 30 mM sodium hypochlorite, with or without s.c. injection of taurine, until the end of the experiment in week 52. Treatment with both ammonium acetate and sodium hypochlorite significantly increased the incidence of gastric cancers in week 52, while the concomitant use of taurine with ammonium acetate and sodium hypochlorite significantly attenuated the enhanced gastric carcinogenesis. Spectrophotometric examinations revealed that taurine scavenged monochloramine. These findings suggest that Helicobacter pylori-associated gastric carcinogenesis may be mediated by monochloramine.

Topics: Animals; Body Weight; Chloramines; Cocarcinogenesis; Gastric Mucosa; Helicobacter Infections; Helicobacter pylori; Male; Methylnitronitrosoguanidine; Rats; Rats, Wistar; Sodium Acetate; Sodium Hypochlorite; Stomach Neoplasms; Taurine

The cleansing effectivity of citric acid solution was significantly better than that of Neomagnol both with respect to the removal of the Smear Layer (SL) and to the number of visible dentinal tubular orifices, however a complete elimination of the SL could not be obtained. Neomagnol seemed to be more effective in the removal of superficial debris and tissue-remnants.

Topics: Chloramines; Citrates; Citric Acid; Dental Instruments; Detergents; Humans; Hungary; In Vitro Techniques; Root Canal Therapy; Sodium Hypochlorite; Solutions; Therapeutic Irrigation

Nowadays carnosine is considered as a promising drug for different diseases. However, mechanism of its action has not been found yet. The study evaluated the interaction between carnosine and sodium hypochlorite. It is established that this reaction yields a stable chloramine complex which is likely to underlie the effect of the drug in cataracts.

Topics: Animals; Carnosine; Cataract; Cattle; Chloramines; Drug Interactions; Humans; Sodium Hypochlorite

We have previously described a micronucleus test using erythrocytes from larvae of the urodele amphibian Pleurodeles waltl (pleurodele). The test is based on a comparison of the levels of micronucleated erythrocytes in blood smears from larvae reared in water containing a clastogen, with the levels from larvae reared in purified water. We have employed this test to evaluate mutagenic activity of chlorinated or monochloraminated water devoid of all organic matter. (i) The level of micronuclei in erythrocytes was compared between a group of larvae reared for 12 days in chlorinated reconstituted ultrapure water treated with sodium hypochlorite, and a control group reared in just the reconstituted water. Sodium hypochlorite was added when both the food and medium were changed each day. Chlorine levels of 0.125 and 0.25 p.p.m. led to significant elevations of micronuclei. (ii) The possibility of indirect effects of chlorine through chemical interactions with the food were also investigated, using the following scheme: larvae were left for 3 h in chlorinated reconstituted ultrapure water and then placed in non-chlorinated water. Food was only introduced when they were transferred to the non-chlorinated water. This procedure was repeated for 12 consecutive days. Control larvae were reared in non-chlorinated water throughout this period. In this case results were also positive when the larvae were exposed for only 3 h to the chlorine (0.2 p.p.m. for 12 days) in the absence of food. (iii) This was the same as experiment 1 except that the water was chlorinated with monochloramine instead of sodium hypochlorite.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Chloramines; Chlorine; Dose-Response Relationship, Drug; Erythrocytes; Larva; Micronucleus Tests; Mutagens; Pleurodeles; Sodium Hypochlorite; Water

The median lethal dose (LD 50) of endodontic antiseptics sodium hypochlorite, chloramine and chlorhexidine digluconate was determined in experiment on albino mice using the method described by Litchfield and Wilcoxon. Sodium hypochlorite and chloramine have shown a twice stronger toxic effect than chlorhexidine digluconate. The difference was significant.

Topics: Animals; Chloramines; Chlorhexidine; Mice; Root Canal Irrigants; Sodium Hypochlorite

Male Sprague-Dawley rats were exposed to chlorine-based disinfectants in the drinking water from weaning to 12 weeks of age, at which time they were terminated and assessed for immune competence. Chlorine-based drinking water disinfectants used were sodium hypochlorite (5, 15 and 30 ppm) and monochloramine (9, 19 and 38 ppm). Parameters of immunity measured were spleen and thymus weights, antibody production, delayed-type hypersensitivity (DTH) reactions, natural killer cell (NKC) cytotoxicity, oxidative metabolism response (i.e chemiluminescence-CL) and phagocytosis by macrophages, and production of 2 immunoregulatory cytokines, interleukin 2 (IL2) and prostaglandin E2 (PGE2). Significant (P less than or equal to 0.05) reductions of spleen weight, DTH reactions, and oxidative metabolism by macrophages were observed only in groups of rats exposed to high levels (30 ppm) of sodium hypochlorite, while PGE2 production was elevated. Rats exposed to the higher doses of monochloramine had reduced spleen weights (38 ppm), decreased antibody synthesis (9 and 19 ppm) and augmented PGE2 production (19 and 38 ppm). These results extend the earlier observations of others that macrophage function of laboratory rodents may be impaired by exposure to high concentrations of chlorinated drinking water. Furthermore, the function of other major populations of immunocytes and types of immune responses may also be altered following subchronic exposure to high concentrations of chlorinated drinking water. These types of effects on the immune system are a previously unrecognized potential side-effect of the ubiquitous practice of disinfection of water with chlorine compounds. Alteration of immune function of chlorine-based disinfectant-exposed rats in this study was only evident at relatively high doses, and only selected immune responses were altered. It appears, therefore, that these chlorine-based disinfectants are not particularly strong immunodepressants. However, further studies in different species may be warranted in order to better extrapolate to implications to human health following chronic low-level exposure.

Topics: Animals; Chloramines; Dinoprostone; Disinfectants; Enzyme-Linked Immunosorbent Assay; Hypersensitivity, Delayed; Immunity; Immunoglobulin G; Interleukin-2; Killer Cells, Natural; Male; Organ Size; Oxidation-Reduction; Phagocytosis; Prostaglandins E; Rats; Rats, Inbred Strains; Sodium Hypochlorite; Water Supply

Topics: Alcohols; Chloramines; Chlorhexidine; Disinfectants; Drug Contamination; Humans; Iodophors; Peritoneal Dialysis; Sodium Hypochlorite

Female SENCAR mice were treated with aqueous solutions of hypochlorous acid (HOCl), sodium hypochlorite (NaOCl), chlorine dioxide (ClO2), and monochloramine (NH2Cl) by whole body exposure (except head) for a 10-min period for 4 days in the first experiment and for 1 day (except NH2Cl) in the second experiment. Animals were sacrificed the day following the last treatment (experiment 1) or on day 1, 2, 3, 4, 5, 8, 10, and 12 following treatment (experiment 2), and skin thickness was measured by light microscopy at X400 by use of an eyepiece micrometer. Concentrations of disinfectants were 1, 10, 100, 300, and 1000 mg/L, for experiment 1 and 1000 mg/L for experiment 2. Thickness of the interfollicular epidermis (IFE) for control animals was 15.4 +/- 1.5 micron. After 4 days of treatment at 1000 mg/L, HOCl and ClO2 increased thickness to 39 +/- 7.0 and 40.2 +/- 11.8, and NaOCl increased thickness to 25.2 +/- 6.1 micron. Only HOCl and ClO2 were tested at 300 mg/L, yielding an IFE thickness of 30.0 +/- 13.1 and 16.8 +/- 0.8 micron, respectively. The response to HOCl was found to be dose-related; the minimally effective dose was 100 mg/L. In earlier, preliminary tests to determine optimum treatment schedule, the response to HOCl appeared to be maximal after 4 days of treatment and tended to decrease with further treatment. The time-course study following a single treatment of 1000 mg/L HOCl, however, showed a progression of IFE thickening of from 18.3 +/- 1.4 at 1 day to 30.8 +/- 8.0 at 8 days, decreasing to 19.1 +/- 6.2 micron at 12 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Chloramines; Chlorine; Chlorine Compounds; Disinfectants; Disinfection; Female; Hyperplasia; Hypochlorous Acid; Mice; Oxides; Skin; Sodium Hypochlorite; Water Supply

Patients receiving hemodialysis therapy risk exposure to both disinfectants and sterilants. Dialysis equipment is disinfected periodically with strong solutions of hypochlorite or formaldehyde. More recently, reuse of dialyzers has introduced the use of additional sterilants, such as hydrogen peroxide and peracetic acid. The use of these sterilants is recognized by the center staffs and the home patient as a potential risk, and residue tests are carried out for the presence of these sterilants at the ppm level. Gross hemolysis resulting from accidental hypochlorite infusion has led to cardiac arrest, probably as a result of hyperkalemia. Formaldehyde is commonly used in 4% solutions to sterilize the fluid paths of dialysis controllers and to sterilize dialyzers before reuse. It can react with red cell antigenic surfaces leading to the formation of anti-N antibodies. Such reactions probably do not occur with hypochlorite or chloramines. The major exposure risk is the low concentration of disinfectant found in municipal water used to prepare 450 L dialysate weekly. With thrice-weekly treatment schedules, the quality requirements for water used to make this solution must be met rigorously. Standards for water used in the preparation of dialysate have recently been proposed but not all patients are treated with dialysate meeting such standards. The introduction of sterilants via tap water is insidious and has led to more pervasive consequences. Both chlorine and chloramines, at concentrations found in potable water, are strong oxidants that cause extensive protein denaturation and hemolysis. Oxidation of the Fe2+ in hemoglobin to Fe3+ forms methemoglobin, which is incapable of carrying either O2 or CO2.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Chloramines; Disinfectants; Formaldehyde; Humans; Kidney Failure, Chronic; Peroxides; Renal Dialysis; Sodium Hypochlorite; Water Supply

Topics: Ammonia; Chloramines; Chlorides; Gas Poisoning; Humans; Sodium Hypochlorite; Toxicology

Topics: Bacteria; Borates; Chloramines; Emulsions; Sodium Hypochlorite; Thiram