Antimicrobial efficacy of pineapple extract Bromelain against Enterococcus faecalis in infected root canals: A systematic review

Background: Enterococcus faecalis, an anaerobic Gram-positive coccus, is commonly associated with failed endodontic treatment. E. faecalis is resistant to conventional antibiotic therapy. Yet other materials like bromelain are investigated for its activity against E. faecalis. Aim: To review the literature and compile them to comprehensively enumerate and present the antimicrobial efficacy of pineapple extract bromelain against E. faecaliss. Materials and Methods: To find articles published up until August 31, 2024, a literature search was conducted. The papers were examined independently by two reviewers. Results: Out of the five studies selected based on the inclusion and exclusion criteria, four studies were in vitro, and one was a randomized controlled trial. All the studies reported that bromelain has excellent antimicrobial activity against E. faecalis. Conclusion: Bromelain extract has a promising role as a root canal irrigant or medication due to its effective antimicrobial effects against E. faecalis. However, as most of the studies are conducted in vitro, there is a need to conduct more in vitro studies on the human infected canals to draw definitive conclusions for their definitive role in endodontics.