Nanosilver as a disinfectant in dental unit waterlines: Assessment of the physicochemical transformations of the AgNPs

Initial waterline contamination by Pseudomonas aeruginosa in newly installed dental chairs

Water contamination in dental unit waterlines (DUWLs) is a potential source of healthcare-associated infection during dental care. The aim of this study was to evaluate the microbiological quality of DUWLs water from newly installed dental chairs in a French University Hospital. The microbiological quality of water from 24 new DUWLs initially disinfected by ICX Renew-prior to use of the dental units for patient treatment-was assessed for total culturable aerobic bacteria at 22°C and 36°C, Legionella sp., Pseudomonas aeruginosa, and total coliforms. Among the 24 samples analyzed, 21 were compliant with the water quality levels: 19 had no bacteria, and 2 contained only 4 and 1 CFU/mL for total culturable aerobic bacteria at 22°C and 36°C, respectively. Three samples were non-compliant due to contamination by P. aeruginosa (4, 2, and 2 CFU/100 mL). Controlling and preventing the microbiological contamination of DUWLs, especially by pathogenic bacteria, at the time of the installation of the new dental chairs are crucial to prevent healthcare-associated infection in dentistry.

IMPORTANCE

Dental unit waterlines (DUWLs) of new dental chairs may be contaminated before their first clinical use, so an initial shock disinfection is crucial at the time of their installation. The microbiological analyses are crucial to control the water quality of DUWLs before their first clinical use because their disinfection does not guarantee the elimination of all bacteria.

Comparative evaluation of effect of sodium hypochlorite and chlorhexidine in dental unit waterline on aerosolized bacteria generated during dental treatment

BACKGROUND

In dentistry, nosocomial infection poses a great challenge to clinicians. The microbial contamination of water in dental unit waterlines (DUWLs) is ubiquitous. Such infected DUWLs can transmit oral microbes in the form of aerosols. Previous studies have suggested treating DUWLs with various disinfectants to reduce cross-contamination. The literature lacks a comparative evaluation of the effect of the use of 0.2% chlorhexidine (CHX) and 0.1% sodium hypochlorite (NaOCl) in DUWLs on aerosolized bacteria generated during dental procedures.

OBJECTIVE

To compare the effect of NaOCl and CHX in DUWLs on aerosolized bacteria generated during restorative and endodontic procedures.

MATERIALS AND METHODS

A total of 132 patients were equally divided into three groups (n = 44 in each group) according to the content of DUWL as follows. Group I-0.1% NaOCl Group II-0.2% CHX Group III-distilled water (Positive control) One-way ANOVA was performed and the Kruskal-Wallis test was used for intergroup comparison.

RESULTS

For the restorative procedure, inter-group comparison of mean colony-forming units (CFU) scores showed a statistically significant difference between the groups (p - .001) with the score of group 3 higher than group 2 followed by group 1. For the endodontics, an inter-group comparison of CFU scores showed a statistically significant difference between the groups (p - .003) with the mean score in group 1 being the lowest and group 3 being the highest.

CONCLUSION

The addition of NaOCl or CHX in DUWLs shows an effective reduction in aerosolized bacteria compared to distilled water.

In-situ photoreduction strategy for synthesis of silver nanoparticle-loaded PVDF ultrafiltration membrane with high antibacterial performance and stability

Ultrafiltration (UF) technology using polyvinylidene fluoride (PVDF) membrane has been widely applied to water and wastewater treatment due to its low cost and simple operation process. However, PVDF-based UF membrane always encountered the issue of membrane biofouling that greatly impacted the filtration performance. In this study, we prepare a silver nanoparticle (AgNP)-loaded PVDF (Ag/PVDF) UF membrane by an in-situ photoreduction method to mitigate the membrane biofouling. Different from the previously reported method, AgNPs were synthesized in-situ by a UV photoreduction process, in which Ag⁺ ions were reduced to zero-valent Ag nanoparticles by the photo-induced reducing radicals. Antibacterial experiments showed that the inhibition efficiency of Ag/PVDF membrane to Escherichia coli reached up to ~ 99% after antibacterial treatment for 24 h. In comparison with the pristine PVDF membrane, Ag/PVDF membrane possessed a lower water contact angle (83.7° vs. 38.1°), and its pure water flux increased by 23.7%, and a high bovine serum albumin (BSA) rejection efficiency was maintained. In addition, the high stability of the Ag/PVDF composite membrane was confirmed by the extremely low releasing amount of Ag. This study provides a novel strategy for the preparation of metal nanoparticle-incorporated Ag/PVDF ultrafiltration composite membrane showing favorable antibacterial performance and stability.

The Application of Silver to Decontaminate Dental Unit Waterlines-a Systematic Review

The contamination of dental unit waterlines (DUWLs) is a major health concern since it can pose cross-infection risks among dental professionals and their patients. Silver is one of the widely used metals in medical fields due to its superior antimicrobial properties. Silver-based agents have been commercially available for the decontamination of dental unit water currently. This systematic review aims to examine the evidence supporting efficacy and safety of application of silver to decontaminate DUWLs. We performed a search of the peer-review literature of studies in six electronic databases using corresponding search terms. Eligibility was restricted to English-language studies exploring the application of silver to decontaminate dental unit water, e.g., silver-based disinfectants and silver-coated dental waterlines tubing. The search identified 148 articles, and 9 articles that met the criteria were synthesized with qualitative narrative analyses. We observed good evidence of antimicrobial efficacy of silver with hydrogen peroxide on diverse microorganism present in DUWLs. Furthermore, there is insufficient evidence on the application of silver nanoparticles (AgNPs) as an efficient material to control the biofilms in DUWLs. Post-treatment data of either the bactericidal and bacteriostatic effects of silver or AgNPs, especially the actual clinical efficacy of long-term application, are scarce. More high-quality research is needed to resolve the gap on the optimal dosage and treatment options required to control bacterial and biofilm in DUWLs with silver-containing materials.

Disinfection methods of dental unit waterlines contamination: a systematic review

Background. Severe contamination of dental unit waterlines was found in healthcare settings. The benefits of decontamination methods are controversial. The aim of this review was to systematically evaluate disinfection methods in contamination control of dental unit waterlines.Methods. The terms 'dental unit waterline(s) or DUWL(s) or dental unit water line(s)' were searched through PubMed, Cochrane Library, Embase, Web of Science and Scopusup to 31 May 2021. The DUWLs' output water was incubated on R2A agar at 20-28 °C for 5-7 days to evaluate heterotrophic mesophilic bacteria. The risk of bias was evaluated by a modified Newcastle-Ottawa quality assessment scale.Results. Eighteen papers from the literature were included. One study indicated that water supply played a crucial role in disinfecting DUWLs. Three studies indicated that flushing decreased bacteria counts but did not meet the American CDC standard (500 c.f.u. ml^-1). All chlorine- and peroxide-containing disinfectants except sodium hypochlorite in one of 15 studies as well as three mouthrinses and citrus botanical extract achieved the standard (≤500 c.f.u. ml^-1). The included studies were of low (1/18), moderate (6/18) and high (11/18) quality.Conclusion. Independent water reservoirs are recommended for disinfecting DUWLs using distilled water. Flushing DUWLs should be combined with disinfections. Nearly all the chlorine-, chlorhexidine- and peroxide-containing disinfectants, mouthrinses and citrus botanical extract meet the standard for disinfecting DUWLs. Alkaline peroxide would lead to tube blockage in the DUWLs. Regularly changing disinfectants can reduce the risk of occurrence of disinfectant-resistant strains of microbes.

Distinct Microbial Community of Accumulated Biofilm in Dental Unit Waterlines of Different Specialties

The contamination of dental unit waterlines (DUWLs) is a serious problem and directly affects the dental care. This study aims to explore the microbial community of biofilm in DUWL from different specialties and investigate the associated factors. A total of 36 biofilm samples from 18 DUWL of six specialties (i.e., prosthodontics, orthodontics, pediatrics, endodontics, oral surgery, and periodontics) at two time points (i.e., before and after daily dental practice) were collected with a novel method. Genomic DNA of samples was extracted, and then 16S ribosomal DNA (rDNA) (V3–V4 regions) and ITS2 gene were amplified and sequenced. Kruskal–Wallis and Wilcoxon rank test were adopted for statistical analysis. Microbial community with high diversity of bacteria (631 genera), fungi (193 genera), and viridiplantae was detected in the biofilm samples. Proteobacteria was the dominant bacteria (representing over 65.74–95.98% of the total sequences), and the dominant fungi was Ascomycota (93.9–99.3%). Microorganisms belonging to multiple genera involved in human diseases were detected including 25 genera of bacteria and eight genera of fungi, with relative abundance of six genera over 1% (i.e., Acinetobacter, Pseudomonas, Enterobacter, Aspergillus, Candida, and Penicillium). The biofilm microbiome may be influenced by the characteristics of dental specialty and routine work to some extent. The age of dental chair unit and overall number of patients had the strongest impact on the overall bacteria composition, and the effect of daily dental practices (associated with number of patients and dental specialty) on the fungi composition was the greatest. For the first time, biofilm in DUWL related to dental specialty was comprehensively evaluated, with more abundance of bacterial and fungal communities than in water samples. Biofilm accumulation with daily work and multiple kinds of opportunistic pathogen emphasized the infectious risk with dental care and the importance of biofilm control.

Applications of nano-materials in diverse dentistry regimes

Research and development in the applied sciences at the atomic or molecular level is the order of the day under the domain of nanotechnology or nano-science with enormous influence on nearly all areas of human health and activities comprising diverse medical fields such as pharmacological studies, clinical diagnoses, and supplementary immune system. The field of nano-dentistry has emerged due to the assorted dental applications of nano-technology. This review provides a brief introduction to the general nanotechnology field and a comprehensive overview of the synthesis features and dental uses of nano-materials including current innovations and future expectations with general comments on the latest advancements in the mechanisms and the most significant toxicological dimensions.

Bacteriostatic effects of nanometer silver disinfectant on the biofilms in dental unit water lines

Background/purpose

Dental unit water lines (DUWLs) may be contaminated by aerobic bacteria in clinical settings and comprehensive disinfecting methods should be considered without delay. Herein, this study aims to investigate the timeliness and dynamic bacteriostatic effects of different forms of nanometer silver (NMS) disinfectant on bio-film in DUWLs.

Materials and methods

Bacterial DUWLs samples were respectively treated with different NMS forms, including liquid phase and solid phase at the concentrations of 0.25%, 0.5%, 1% and 2% and their bacteriostatic effects were observed at the 1st, 4th, 7th, 14th, ^28th day.

Results

The bacteriostatic effects of liquid phase NMS at all concentrations were unsatisfactory and the bacteriostatic rate was only 20% at the 1st day. However, there appeared massive bacteria growth at the 4th, 7th, 14th, 28th day. Comparatively, no bacteria growth was found at the 1st, 4th, 7th, 14th, ^28th day after sterilizing with different concentrations of solid phase NMS and the bacteriostatic rate was 100%.

Conclusion

Microbial contamination in DUWLs can be disinfected by different NMS forms, among which solid phase NMS is more bactericidal against bacteria bio-films, demonstrating significant roles of solid phase NMS in preventing DUWL contamination.

Efficacy of BRS® and Alpron®/Bilpron® Disinfectants for Dental Unit Waterlines: A Six-Year Study

Biofilms in dental unit waterlines (DUWL) are a potentially significant source of contamination posing a significant health risk as these may come into contact with patients and dental staff during treatment. The aim of this study was to evaluate the microbiological quality of DUWL water treated by Biofilm-Removing-System^® (BRS^®) and Alpron^®/Bilpron^® disinfectant solutions for six years in a French university hospital. The microbiological quality of water supplied by 68 dental units—initially shock treated with BRS^®, then continuously treated by Alpron^® with sterile water during working days and Bilpron^® during inactivity period, and combined with purging every morning and after each patient—was assessed biannually during six years for total culturable aerobic bacteria at 22 °C and 36 °C, Legionella sp., Pseudomonas aeruginosa, and total coliforms. A total of 628 samples were analyzed, 99.8% were compliant with extended microbiological levels, and we never detected pathogen bacteria like Legionella sp. and P. aeruginosa. Only one sample (0.2%) was noncompliant with the level of total culturable aerobic bacteria at 36 °C, which exceeded 140 colony forming units per mL. The protocol implemented in our university hospital gives excellent results and enables control of the microbiological quality of DUWL water in the long term.

Plasma Sterilization Effectively Reduces Bacterial Contamination in Dental Unit Waterlines

Objective

To investigate the effectiveness of plasma sterilization in reducing bacterial contamination and controlling biofilms in dental unit waterlines.

Materials and Methods

Ten identical dental chair units (DCUs) were used. Five DCUs were installed with an automated plasma sterilization system (PSS) and the other five were kept as nontreated controls (CTL). Water flushed from the airotor line served as the output water of the dental unit waterlines (DUWLs). Water samples were collected at the beginning and on a weekly basis for 4 months. Water was analyzed for bacterial contamination (CFU/mL). Scanning electron microscopy (SEM) was used to investigate the amount of biofilm in the waterlines. Biofilm viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assays. All statistical analyses were performed using the Mann-Whitney U test. A value of p < 0.05 was considered significant.

Results

The DCU output water was found to be heavily contaminated with bacteria. Plasma sterilization effectively reduced bacterial contamination from an average of 212 CFU/mL to 8 CFU/mL. During the entire period of 4 months, the level remained below 500 CFU/mL, the standard level recommended by the Centers for Disease Control and Prevention (CDC) of the USA. The reduction in the bacterial count was significant compared with the CTL group (p < 0.05). Plasma sterilization could not eradicate the existing biofilms in the waterlines, and it did reduce biofilm mass and viability. Moreover, treatment with plasma sterilization did not induce a change in the composition of microorganisms, as analyzed by Gram staining.

Conclusion

Plasma sterilization, which is part of electrochemically activated water, effectively reduces bacterial contamination and reduces biofilms in dental unit waterlines.

Dissolution of Silver Nanoparticles in Colloidal Consumer Products: Effects of Particle Size and Capping Agent

The utilization of silver nanoparticles (AgNPs) in consumer products has significantly increased in recent years, primarily due to their antimicrobial properties. Increased use of AgNPs has raised ecological concerns. Once released into an aquatic environment, AgNPs may undergo oxidative dissolution leading to the generation of toxic Ag+. Therefore, it is critical to investigate the ecotoxicological potential of AgNPs and determine the physicochemical parameters that control their dissolution in aquatic environments. We have investigated the dissolution trends of aqueous colloidal AgNPs in five products, marketed as dietary supplements and surface sanitizers. The dissolution trends of AgNPs in studied products were compared to the dissolution trends of AgNPs in well-characterized laboratory-synthesized nanomaterials: citrate-coated AgNPs, polyvinylpyrrolidone-coated AgNPs, and branched polyethyleneimine-coated AgNPs. The characterization of the studied AgNPs included: particle size, anion content, metal content, silver speciation, and capping agent identification. There were small differences in the dissolved masses of Ag+ between products, but we did not observe any significant differences in the dissolution trends obtained for deionized water and tap water. The decrease of the dissolved mass of Ag+ in tap water could be due to the reaction between Ag+ and Cl-, forming AgCl and affecting their dissolution. We observed a rapid initial Ag+ release and particle size decrease for all AgNP suspensions due to the desorption of Ag+ from the nanoparticles surfaces. The observed differences in dissolution trends between AgNPs in products and laboratory-synthesized AgNPs could be caused by variances in capping agent, particle size, and total AgNP surface area in suspensions.

Transformation of Silver Nanoparticle Consumer Products during Simulated Usage and Disposal

Twenty-two silver nanoparticle (AgNP) consumer products (CPs) were analyzed with respect to their silver speciation. Three CPs and three lab-synthesized particles were selected to simulate environmental fate and transport by simulating their intended usage and disposal methods. Since many of these products are meant for ingestion, we simulated their usage by exposing them to human synthetic stomach fluid followed by exposure to wastewater sludge. We found that during the products individual exposure to wastewater sludge, the conversion rate of silver to AgCl and Ag2S was affected by both the amount of silver ion present and the properties of the AgNP. The rates of conversion of metallic silver to silver sulfide was heavily dependent on the particle size for the lab-synthesized particles, with 90 nm PVP-capped particles reacting to a much lesser extent than the 15 nm PVP-capped or the citrate-capped particles. We observed similar sulfidation rates on two of the tested CPs with the 15 nm lab-synthesized particles despite containing silver nanoparticles >5 times larger, indicating the presence of other influencing factors. Pre-treatment with synthetic stomach fluid modified the rates of Ag2S formation. Due to the variable composition of CPs and the conditions they are exposed to between manufacture, sale, use, and disposal, their final composition may be somewhat unpredictable in the environment. In the present study, we have achieved a more accurate approximation of the expected interactions between silver nanoparticle-containing CPs and environmental media by utilizing real CPs and evaluating them with solid phase and aqueous phase analytical techniques.

Similarities and Differences between Silver Ions and Silver in Nanoforms as Antibacterial Agents

Silver is considered as antibacterial agent with well-known mode of action and bacterial resistance against it is well described. The development of nanotechnology provided different methods for the modification of the chemical and physical structure of silver, which may increase its antibacterial potential. The physico-chemical properties of silver nanoparticles and their interaction with living cells differs substantially from those of silver ions. Moreover, the variety of the forms and characteristics of various silver nanoparticles are also responsible for differences in their antibacterial mode of action and probably bacterial mechanism of resistance. The paper discusses in details the aforementioned aspects of silver activity.

Dependence of toxicity of silver nanoparticles on Pseudomonas putida biofilm structure

Susceptibility of biofilms with different physical structures to silver nanoparticles (AgNPs) was studied. Biofilms of Pseudomonas putida KT2440 were formed in batch conditions under different carbon sources (glucose, glutamic acid, and citrate), glucose concentrations (5 and 50 mM), and incubation temperatures (25 and 30 °C). The biofilms were observed using confocal laser scanning microscopy for their physical characteristics (biomass amount, thickness, biomass volume, surface to volume ratio, and roughness coefficient). The biofilms forming under different growth conditions exhibited different physical structures. The biofilm thickness and the roughness coefficient were found negatively and positively correlated with the biofilm susceptibility to AgNPs, respectively. The effect of AgNPs on biofilms was low (1-log reduction of cell number) when the biofilms had high biomass amount, high thickness, high biomass volume, low surface to volume ratio, and low roughness coefficient. Furthermore, the extracellular polymeric substance (EPS) stripping process was applied to confirm the dependence of susceptibility to AgNPs on the structure of biofilm. After the EPS stripping process, the biofilms forming under different conditions showed reduction in thickness and biomass volume, and increases in surface to volume ratio and roughness coefficient, which led to more biofilm susceptibility to AgNPs. The results of this study suggest that controlling the growth conditions to alter the biofilm physical structure is a possible approach to reduce the impact of AgNPs on biofilms in engineered and natural systems.

Silver nanoparticles in dentistry

OBJECTIVE

Silver nanoparticles (AgNPs) have been extensively studied for their antimicrobial properties, which provide an extensive applicability in dentistry. Because of this increasing interest in AgNPs, the objective of this paper was to review their use in nanocomposites; implant coatings; pre-formulation with antimicrobial activity against cariogenic pathogens, periodontal biofilm, fungal pathogens and endodontic bacteria; and other applications such as treatment of oral cancer and local anesthesia. Recent achievements in the study of the mechanism of action and the most important toxicological aspects are also presented.

METHODS

Systematic searches were carried out in Web of Science (ISI), Google, PubMed, SciFinder and EspaceNet databases with the keywords "silver nano* or AgNP*" and "dentist* or dental* or odontol*".

RESULTS

A total of 155 peer-reviewed articles were reviewed. Most of them were published in the period of 2012-2017, demonstrating that this topic currently represents an important trend in dentistry research. In vitro studies reveal the excellent antimicrobial activity of AgNPs when associated with dental materials such as nanocomposites, acrylic resins, resin co-monomers, adhesives, intracanal medication, and implant coatings. Moreover, AgNPs were demonstrated to be interesting tools in the treatment of oral cancers due to their antitumor properties.

SIGNIFICANCE

The literature indicates that AgNPs are a promising system with important features such as antimicrobial, anti-inflammatory and antitumor activity, and a potential carrier in sustained drug delivery. However, there are some aspects of the mechanisms of action of AgNPs, and some important toxicological aspects arising from the use of this system that must be completely elucidated.