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Baudet A, Lizon J, Florentin A, Mortier É. Initial waterline contamination by Pseudomonas aeruginosa in newly installed dental chairs. Microbiol Spectr 2024; 12:e0396223. [PMID: 38652098 PMCID: PMC11237434 DOI: 10.1128/spectrum.03962-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
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.
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Affiliation(s)
- Alexandre Baudet
- Faculté d’odontologie, Université de Lorraine, Nancy, France
- CHRU-Nancy, Service d’odontologie, Nancy, France
- Université de Lorraine, Inserm, INSPIIRE, Nancy, France
| | - Julie Lizon
- Département territorial d’hygiène et prévention du risque infectieux (DTPRI), CHRU-Nancy, Nancy, France
| | - Arnaud Florentin
- Université de Lorraine, Inserm, INSPIIRE, Nancy, France
- Département territorial d’hygiène et prévention du risque infectieux (DTPRI), CHRU-Nancy, Nancy, France
- Département d’hygiène, des risques environnementaux et associés aux soins (DHREAS), Faculté de Médecine, Université de Lorraine, Nancy, France
| | - Éric Mortier
- Faculté d’odontologie, Université de Lorraine, Nancy, France
- CHRU-Nancy, Service d’odontologie, Nancy, France
- CNRS, IJL, Université de Lorraine, Nancy, France
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Hoogenkamp MA, Mazurel D, Deutekom-Mulder E, de Soet JJ. The consistent application of hydrogen peroxide controls biofilm growth and removes Vermamoeba vermiformis from multi-kingdom in-vitro dental unit water biofilms. Biofilm 2023; 5:100132. [PMID: 37346320 PMCID: PMC10279787 DOI: 10.1016/j.bioflm.2023.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/23/2023] Open
Abstract
The water systems inside a dental unit are known to be contaminated with a multi-kingdom biofilm encompassing bacteria, fungi, viruses and protozoa. Aerosolization of these micro-organisms can potentially create a health hazard for both dental staff and the patient. Very little is known on the efficacy of dental unit disinfection products against amoeba. In this study we have examined the effect of four different treatment regimens, with the hydrogen peroxide (H2O2) containing product Oxygenal, on an in-vitro multi-kingdom dental unit water system (DUWS) biofilm. The treatment efficacy was assessed in time using heterotrophic plate counts, the bacterial 16S rDNA, fungal 18S rDNA gene load and the number of genomic units for Legionella spp. the amoeba Vermamoeba vermiformis. The results indicated that a daily treatment of the DUWS with a low dose H2O2 (0.02% for 5 h), combined with a weekly shock dose (0.25% H2O2, 30 min) is necessary to reduce the heterotrophic plate count of a severely contaminated DUWS (>106 CFU.mL-1) to below 100 CFU.mL-1. A daily treatment with a low dose hydrogen peroxide alone, is sufficient for the statistically significant reduction of the total amount of bacterial 16S rDNA gene, Legionella spp. and Vermamoeba vermiformis load (p < 0.005). Also shown is that even though hydrogen peroxide does not kill the trophozoite nor the cysts of V. vermiformis, it does however result in the detachment of the trophozoite form of this amoeba from the DUWS biofilm and hereby ultimately removing the amoeba from the system.
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Affiliation(s)
- Michel A. Hoogenkamp
- Corresponding author. Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, the Netherlands.
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Petchphayaprai C, Chotipan C, Sa-Ngiampak P, Thotsaporn K, Ampornaramveth RS. Effectiveness of iodine for continuous decontamination of dental unit waterline. BDJ Open 2023; 9:34. [PMID: 37481614 PMCID: PMC10363156 DOI: 10.1038/s41405-023-00160-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 07/24/2023] Open
Abstract
OBJECTIVE Dental Unit Waterlines (DUWLs) are contaminated by various species of microorganisms. DUWLs should be disinfected appropriately to control microbial contamination. This study investigated the effectiveness of devices continuously releasing iodine to control microbial contamination in DUWLs. MATERIALS AND METHODS Ten dental chair units (DCU) at Chulalongkorn University were randomized into the iodine and control groups. After setting iodine treatment devices, the DCU was allowed to operate normally. 25 ml of water from airotors lines were collected weekly for enumerating bacteria. The viability of biofilms in DUWLs was quantified by ATP testing kit. The amount of iodine released into the procedural water was also quantified. RESULTS The continuous presence of iodine could significantly control bacterial contamination in the DUWL to be less than 500 CFU/mL, the standard level recommended by the Centre for Disease Control and Prevention (CDC). Iodine treatment can reduce bacterial CFU up to 98-100%. Biofilm viability in the iodine group was slightly lower than that of the control group though not statistically significant. After eleven months, the average iodine release was measured to be 3.6 ppm which is still effective in controlling bacterial contamination. CONCLUSION Continuously supplying iodine in DUWLs effectively controls microbial contamination.
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Affiliation(s)
- Chatchaya Petchphayaprai
- Center of Excellence on Oral Microbiology and Immunology, Department of Microbiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Chutimon Chotipan
- Center of Excellence on Oral Microbiology and Immunology, Department of Microbiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Pitchayapa Sa-Ngiampak
- Center of Excellence on Oral Microbiology and Immunology, Department of Microbiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Kittisak Thotsaporn
- Department of Biochemistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
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Marino F, Mazzotta M, Pascale MR, Derelitto C, Girolamini L, Cristino S. First water safety plan approach applied to a Dental Clinic complex: identification of new risk factors associated with Legionella and P. aeruginosa contamination, using a novel sampling, maintenance and management program. J Oral Microbiol 2023; 15:2223477. [PMID: 37346998 PMCID: PMC10281406 DOI: 10.1080/20002297.2023.2223477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
Dental unit waterlines (DUWLs) represent a complex environment able to promote microbial contamination, due to functional, mechanical and practical risk factors. According to a water safety plan approach, the main goal is to preserve the health of dentists, dental staff and patients. The aim of this study is to develop a DUWLs water safety plan that is able to support correct and effective maintenance and disinfection procedures. Three different water systems serve 60 dental chairs: (i) water that comes directly from municipal water (Type A), (ii) water supplied by municipal water and water bottles (Type B) and (iii) water supplied only via water bottles (Type C). For each type, Legionella and Pseudomonas aeruginosa contamination was studied, by applying a new sampling scheme, based on separate sampling from water bottles, cup filler and handpieces. Type B DUWL is the only type of DUWL contaminated by L. pneumophila (ST 59) and L. anisa (mean contamination: 608.33 ± 253.33 cfu/L) detected in cup filler and handpieces, as well as the high presence of P. aeruginosa (44.42 ± 13.25 cfu/100 mL). Two subsequent shock treatments and resampling procedures were performed by increasing disinfectant dosage and contact time and removing some DUWL components linked to biofilm growth in DUWLs. A significant reduction of contamination was obtained for both microorganisms (Legionella spp.: -100%, p < 0.001 and P. aeruginosa: -99.86%, p = 0.006). The sampling strategy proposed allows us to identify the source of contamination and better focus on the maintenance and disinfection procedures. DUWLs represent an environment that requires a multidisciplinary approach, combining the knowledge of all DUWL components to correct procedures that are able to preserve the health of personnel and patients, as well as guaranteeing DUWLs' safe functionality.
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Affiliation(s)
- Federica Marino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- Department of Civil, Chemical, Environmental and Materials Engineering, University of Bologna, Bologna, Italy
| | - Carlo Derelitto
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
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Totaro M, Badalucco F, Papini F, Grassi N, Mannocci M, Baggiani M, Tuvo B, Casini B, Menchini Fabris GB, Baggiani A. Effectiveness of a Water Disinfection Method Based on Osmosis and Chlorine Dioxide for the Prevention of Microbial Contamination in Dental Practices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10562. [PMID: 36078275 PMCID: PMC9518534 DOI: 10.3390/ijerph191710562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
In dental clinics, the infections may be acquired through contaminated devices, air, and water. Aerosolized water may contain bacteria, grown into the biofilm of dental unit waterlines (DUWLs). We evaluated a disinfection method based on water osmosis and chlorination with chlorine dioxide (O-CD), applied to DUWL of five dental clinics. Municipal water was chlorinated with O-CD device before feeding all DUWLs. Samplings were performed on water/air samples in order to research total microbial counts at 22-37 °C, Pseudomonas aeruginosa, Legionella spp., and chlorine values. Water was collected from the taps, spittoons, and air/water syringes. Air was sampled before, during, and after 15 min of aerosolizing procedure. Legionella and P. aeruginosa resulted as absent in all water samples, which presented total microbial counts almost always at 0 CFU/mL. Mean values of total chlorine ranged from 0.18-0.23 mg/L. Air samples resulted as free from Legionella spp. and Pseudomonas aeruginosa. Total microbial counts decreased from the pre-aerosolizing (mean 2.1 × 102 CFU/m3) to the post-aerosolizing samples (mean 1.5 × 10 CFU/m3), while chlorine values increased from 0 to 0.06 mg/L. O-CD resulted as effective against the biofilm formation in DUWLs. The presence of residual activity of chlorine dioxide also allowed the bacteria reduction from air, at least at one meter from the aerosolizing source.
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Affiliation(s)
- Michele Totaro
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Federica Badalucco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Francesca Papini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Niccolò Grassi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Marina Mannocci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | | | - Benedetta Tuvo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | | | - Angelo Baggiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
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Talapko J, Frauenheim E, Juzbašić M, Tomas M, Matić S, Jukić M, Samardžić M, Škrlec I. Legionella pneumophila-Virulence Factors and the Possibility of Infection in Dental Practice. Microorganisms 2022; 10:microorganisms10020255. [PMID: 35208710 PMCID: PMC8879694 DOI: 10.3390/microorganisms10020255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/08/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Legionella pneumophila is defined as a bacterium that can cause severe pneumonia. It is found in the natural environment and in water, and is often found in water tanks. It can be an integral part of biofilms in nature, and the protozoa in which it can live provide it with food and protect it from harmful influences; therefore, it has the ability to move into a sustainable but uncultured state (VBNC). L. pneumophila has been shown to cause infections in dental practices. The most common transmission route is aerosol generated in dental office water systems, which can negatively affect patients and healthcare professionals. The most common way of becoming infected with L. pneumophila in a dental office is through water from dental instruments, and the dental unit. In addition to these bacteria, patients and the dental team may be exposed to other harmful bacteria and viruses. Therefore, it is vital that the dental team regularly maintains and decontaminates the dental unit, and sterilizes all accessories that come with it. In addition, regular water control in dental offices is necessary.
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Affiliation(s)
- Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
| | - Erwin Frauenheim
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
| | - Martina Juzbašić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
| | - Matej Tomas
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
| | - Suzana Matić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia
| | - Melita Jukić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
- General Hospital Vukovar, Županijska 35, HR-32000 Vukovar, Croatia
| | - Marija Samardžić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
- Correspondence:
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Mehrotra V, Aslam S, Garg K, Srivastava R, Sinha P, Kiran J. Knowledge, attitude, and practices regarding sterilization protocol among dental students at Kanpur, Uttar Pradesh: A percentage-based study. THE SAINT'S INTERNATIONAL DENTAL JOURNAL 2022. [DOI: 10.4103/sidj.sidj_8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hoogenkamp MA, Brandt BW, Laheij AMGA, de Soet JJ, Crielaard W. The microbiological load and microbiome of the Dutch dental unit; 'please, hold your breath'. WATER RESEARCH 2021; 200:117205. [PMID: 34058484 DOI: 10.1016/j.watres.2021.117205] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
Dental unit water systems are prone to biofilm formation. During use of the dental unit, clumps of biofilm slough off and can subsequently be aerosolized and inhaled by both patient and staff, potentially causing infections. The aim of this study was to determine the microbial load and microbiome of dental unit water, in the Netherlands, and the factors influencing these parameters. In total, 226 dental units were sampled and heterotrophic plate counts (HPC) were determined on the traditional effluent sample. Of all dental units, 61% exceeded the recommended microbiological guidelines of 100 colony forming units per milliliter. In addition, the microbiome, with additional q-PCR analysis for specific species, was determined on an effluent sample taken immediately after an overnight stagnancy period, in which the biofilm is in its relaxed state. These relaxed biofilm samples showed that each dental unit had a unique microbiome. Legionella spp., amoeba and fungi were found in 71%, 43% and 98% of all units, respectively. The presence of amoeba was positively associated with nine bacterial biomarkers and correlated positively with bacterial and fungal DNA and Legionella spp. concentrations, but not with HPC. Only when adhering to disinfection protocols, statistically significant effects on the microbial load and microbiome were seen. The relaxed biofilm sample, in combination with molecular techniques gives better insight in the presence of opportunistic pathogens when compared to the heterotrophic plate counts. Infection control measures should focus on biofilm analysis and control in order to guarantee patient safety.
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Affiliation(s)
- Michel A Hoogenkamp
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Bernd W Brandt
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alexa M G A Laheij
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Johannes J de Soet
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Wim Crielaard
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Mutluay M, Egil E. Effect of work environment and specialty degree of dentists on cross-infection control in COVID-19 pandemic. Braz J Infect Dis 2021; 25:101592. [PMID: 34153223 PMCID: PMC8165091 DOI: 10.1016/j.bjid.2021.101592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives The aim of this study was to evaluate the effect of the work environment and expertise/specialty degree of dentists on their behavior, awareness, and attitudes regarding cross-infection control during the COVID-19 pandemic. Design The study population consisted of Turkish dentists who work in private clinics, public clinics and university hospitals. The demographic information of the participants, their awareness of the COVID-19 acute respiratory disease, and clinical measures taken against cross-infection were evaluated with an online survey. Between the 10th and 20th of November 2020, 2,400 surveys were e-mailed to dentists. Results A total 454 professionals answered the survey. According to the results, 29.3% of the participants performed only urgent care during the pandemic period, whereas 59.9% of them performed both urgent and routine treatments. Among the responding dentists, 90.6% stated that they were worried about aerosol-generating dental procedures, but there was no differences between genders (p = 0.119). Most participants, especially specialists (p = 0.160) , applied strict cross-infection control methods during the COVID-19 pandemic (77.2%). These dentists used personal protective equipment (PPE) at rates that varied between 75.5% and 98.4%. Nonetheless, the rate of PPE use was different between genders and degrees of expertise: women used PPE more frequently than men (p = 0.025), and specialists used PPE more often than the other dentists (p = 0.04). Finally, there was a weak positive correlation between the level of PPE use and expertise (r = 0.121; p = 0.010). Conclusions Despite the overall knowledge of the participants regarding COVID-19 symptoms, transmission routes, and the guidelines needed to prevent the virus from spreading, the dental specialists followed infection control methods more strictly. Even though the participants were concerned about dental practices that create microbial aerosols during the pandemic period, they continued their clinical routines using high PPE levels and taking extra clinical precautions to avoid cross-infection.
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Affiliation(s)
- Merve Mutluay
- Kirikkale University, Vocational School of Health Services, Department of Dental Hygiene, Kirikkale, Turkey
| | - Edibe Egil
- Istanbul Gelisim University, School of Dentistry, Department of Pediatric Dentistry, Istanbul, Turkey.
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Sun X, Hill P, Liu J, Qian J, Ma Y, Zhou S. Marine-Source Quorum Quenching Enzyme YtnP to Improve Hygiene Quality in Dental Units. Mar Drugs 2021; 19:md19040225. [PMID: 33923695 PMCID: PMC8073825 DOI: 10.3390/md19040225] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/02/2022] Open
Abstract
Biofilm in dental unit water lines may pose a health risk to patients and dental practitioners. An AdiC-like quorum quenching enzyme, YtnP, was cloned from a deep-sea probiotic Bacillus velezensis, and heterologously expressed in E. coli to examine the application on the improvement of hygiene problems caused by biofilm infection of Pseudomonas aeruginosa in dental units. Pseudomonas bacteria were isolated from dental chair units and used to grow static biofilms in the laboratory. A water filter system was designed to test the antifouling activity of YtnP in Laboratory, to simulate the biofilm contamination on water filter in dental unit water lines. The results demonstrated that the enzyme of YtnP was able to degrade the N-acyl homoserine lactones, significantly inhibited the EPS generation, biofilm formation, and virulence factors production (pyocyanin and rhamnolipid) of P. aeruginosa, and was efficient on the antifouling against P. aeruginosa. The findings in this study indicated the possibility of YtnP as novel disinfectant reagent for hygiene treatment in dental units.
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Affiliation(s)
- Xiaohui Sun
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China; (J.L.); (J.Q.); (Y.M.); (S.Z.)
- Correspondence: (X.S.); (P.H.); Tel.: +86-595-616-2305 (X.S.)
| | - Philip Hill
- School of Biosciences, Sutton Bonington Campus, University of Nottingham, Loughbrough LE12 5RD, UK
- Correspondence: (X.S.); (P.H.); Tel.: +86-595-616-2305 (X.S.)
| | - Jia Liu
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China; (J.L.); (J.Q.); (Y.M.); (S.Z.)
| | - Jing Qian
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China; (J.L.); (J.Q.); (Y.M.); (S.Z.)
| | - Yuting Ma
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China; (J.L.); (J.Q.); (Y.M.); (S.Z.)
| | - Shufeng Zhou
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China; (J.L.); (J.Q.); (Y.M.); (S.Z.)
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Experimental Evaluation of Aerosol Production after Dental Ultrasonic Instrumentation: An Analysis on Fine Particulate Matter Perturbation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073357. [PMID: 33805088 PMCID: PMC8036889 DOI: 10.3390/ijerph18073357] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 12/18/2022]
Abstract
Aerosol production represents a major concern during the majority of dental procedures. The aim of the present study is to investigate the dynamics of aerosol particles after 15 min of continuous supragingival ultrasonic instrumentation with no attempt of containment through particle count analysis. Eight volunteers were treated with supragingival ultrasonic instrumentation of the anterior buccal region. A gravimetric impactor was positioned 1 m away and at the same height of the head of the patient. Particles of different sizes (0.3–10 µm) were measured at the beginning of instrumentation, at the end of instrumentation (EI), and then every 15 min up to 105 min. The 0.3-µm particles showed non-significant increases at 15/30 min. The 0.5–1-µm particles increased at EI (p < 0.05), and 0.5 µm remained high for another 15 min. Overall, all submicron aerosol particles showed a slow decrease to normal values. Particles measuring 3–5 µm showed non-significant increases at EI. Particles measuring 10 µm did not show any increases but a continuous reduction (p < 0.001 versus 0.3 µm, p < 0.01 versus 0.5 µm, and p < 0.05 versus 1–3 µm). Aerosol particles behaved differently according to their dimensions. Submicron aerosols peaked after instrumentation and slowly decreased after the end of instrumentation, whilst larger particles did not show any significant increases. This experimental study produces a benchmark for the measurement of aerosol particles during dental procedures and raises some relevant concerns about indoor air quality after instrumentation.
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Bahador M, Alfirdous RA, Alquria TA, Griffin IL, Tordik PA, Martinho FC. Aerosols Generated during Endodontic Treatment: A Special Concern during the Coronavirus Disease 2019 Pandemic. J Endod 2021; 47:732-739. [PMID: 33548332 PMCID: PMC7857011 DOI: 10.1016/j.joen.2021.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The aims of this study were to investigate aerosolized microorganisms generated during endodontic emergencies and nonsurgical root canal therapy (NSRCT), to assess the spread of airborne microbes, and to verify the spatial distribution of airborne microbial spread. METHODS A total of 45 endodontic procedures were sampled, including full pulpotomy (n = 15), pulpectomy (n = 15), and NSRCT (n = 15). Samples were collected during room resting and after treatment. The passive air sampling technique using settle plates was applied. Agar plates were set at different locations in the operatory. The colony-forming unit (CFU) was counted in brain-heart infusion blood agar plates. A set of agar plates containing selective chromogenic culture media was used for the isolation and presumptive identification of target microorganisms. Fungi were investigated using Sabouraud dextrose agar. RESULTS Pulpotomy generated the lowest mean CFU count (P < .05). There was no difference between the mean CFU counts found in pulpectomy and NSRCT (P > .05). A higher mean CFU count was found close to the patient's mouth (0.5 m) than at a 2-m distance in pulpectomy and NSRCT (P < .05). There was no difference between the mean CFU count found in front of the patient's mouth versus diagonal in pulpectomy and NSRCT (P > .05). Staphylococcus aureus (22/45, 48.8%) was the most frequent bacteria species. Longer treatment times were associated with higher CFU counts. CONCLUSIONS Our findings indicated that pulpotomy generates less aerosolized microorganisms than pulpectomy and NSRCT. The proximity to the patient's mouth and the treatment duration were implicated in the level of contamination.
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Affiliation(s)
- Mason Bahador
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Rayyan A Alfirdous
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; Prince Abdulrahman Advanced Dental Institute, Riyadh, Kingdom of Saudi Arabia
| | - Theeb A Alquria
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; Department of Restorative Dental Science, Imam Abdulrahman Bin Faisal University, College of Dentistry, Dammam, Saudi Arabia
| | - Ina L Griffin
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Patricia A Tordik
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Frederico C Martinho
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland.
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13
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Spagnolo AM, Sartini M, Cristina ML. Microbial Contamination of Dental Unit Waterlines and Potential Risk of Infection: A Narrative Review. Pathogens 2020; 9:E651. [PMID: 32823641 PMCID: PMC7460066 DOI: 10.3390/pathogens9080651] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022] Open
Abstract
Several studies have revealed that dental unit waterlines (DUWLs) are often contaminated by large numbers of various micro-organisms (bacteria, fungi, protozoa, viruses). Microbial contamination in DUWLs may originate from the mains water piped into the dental unit, the suck-back of patients' saliva into the line due to the lack of adequate valves, and contamination from bottled water systems. Some of the main determinants of microbial contamination in DUWLs are: a very small lumen size (0.5-2 mm) of the tubing used, high surface-to-volume ratio (6:1), low throughput and the materials of which the tubing is made, water stagnation outside of working hours. The environmental conditions present inside the conduits of the dental unit may facilitate the proliferation of micro-organisms and the consequent formation of biofilm on the interior surface of the pipes of DUWLs. During the use of handpieces, particularly high-speed rotating instruments, a spray is thrown up in the form of aerosols or spatters containing biological material (saliva, blood and dental plaque) and micro-organisms. This means that the health of both dental staff and patients could be at risk of infection. The risk of cross-infections in dental settings can be tackled by implementing combined interventions to prevent the contamination of DUWLs.
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Affiliation(s)
| | - Marina Sartini
- Department of Health Sciences, University of Genova, 16132 Genova, Italy; (A.M.S.); (M.L.C.)
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14
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Zemouri C, de Soet JJ, Volgenant CMC, Crielaard W, Laheij AMGA. Heterogeneity in the efficacy of dental chemical disinfectants on water-derived biofilms in vitro. BIOFOULING 2020; 36:587-596. [PMID: 32580580 DOI: 10.1080/08927014.2020.1782894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 06/11/2023]
Abstract
Conditions in dental unit waterlines are favourable for biofilm growth and contamination of dental unit water. The aim of this study was to assess the effect of several chemical disinfectants on bacteria in a biofilm model. Water-derived biofilms were grown in a static biofilm model (Amsterdam Active Attachment model), using two growth media. Biofilms were challenged with Alpron/Bilpron, Anoxyl, Citrisil, Dentosept, Green & Clean, ICX and Oxygenal in shock dose and maintenance doses. The concentration and the composition of the chemical disinfectants influenced the number of culturable bacteria in the biofilms. The application of a single shock dose followed by a low dose of the same chemical disinfectants resulted in the greatest suppression of viable bacteria in the biofilms. Exposure to Citrisil and ICX consistently resulted in failure to control the biofilms, while Alpron/Bilpron had a substantial and relevant effect on the number of bacteria in the biofilms.
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Affiliation(s)
- C Zemouri
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - J J de Soet
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - C M C Volgenant
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - W Crielaard
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - A M G A Laheij
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
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15
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Tuvo B, Totaro M, Cristina ML, Spagnolo AM, Di Cave D, Profeti S, Baggiani A, Privitera G, Casini B. Prevention and Control of Legionella and Pseudomonas spp. Colonization in Dental Units. Pathogens 2020; 9:E305. [PMID: 32326140 PMCID: PMC7238104 DOI: 10.3390/pathogens9040305] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Dental Unit Waterlines (DUWLs) have shown to be a source of Legionella infection. We report the experience of different dental healthcare settings where a risk management plan was implemented. Materials and methods: In a Hospital Odontostomatology Clinic (HOC) and three Private Dental Clinics (PDCs) housing 13 and six dental units (DUs), respectively, an assessment checklist was applied to evaluate staff compliance with guideline recommendations. DUWLs microbial parameters were investigated before and after the application of corrective actions. Results: In the HOC a poor adherence to good practices was demonstrated, whereas protocols were carefully applied in PDCs. L. pneumophila sg 2-15 was isolated in 31% (4/13) and 33% (2/6) of DUs in HOC and PDCs, respectively, mainly from handpieces (32%, 6/19) with counts >102 colony-forming units per milliliter (CFU/L), often associated with P. aeruginosa (68%, 13/19). The shock disinfection with 3% v/v hydrogen peroxide (HP) showed a limited effect, with a recolonization period of about 4 weeks. Legionella was eradicated only after 6% v/v HP shock disinfection and filters-installation, whilst P. aeruginosa after the third shock disinfection with a solution of 4% v/v HP and biodegradable surfactants. Conclusions: Our data demonstrate the presence and persistence of microbial contamination within the DUWLs, which required strict adherence to control measures and the choice of effective disinfectants.
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Affiliation(s)
- Benedetta Tuvo
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Michele Totaro
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy; (M.L.C.); (A.M.S.)
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy; (M.L.C.); (A.M.S.)
| | - David Di Cave
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Sara Profeti
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Angelo Baggiani
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Gaetano Privitera
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Beatrice Casini
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
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16
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Ditommaso S, Giacomuzzi M, Ricciardi E, Memoli G, Zotti CM. Colonization by Pseudomonas aeruginosa of dental unit waterlines and its relationship with other bacteria: suggestions for microbiological monitoring. JOURNAL OF WATER AND HEALTH 2019; 17:532-539. [PMID: 31313992 DOI: 10.2166/wh.2019.240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pseudomonas aeruginosa is an environmental bacterium, ubiquitous in aquatic habitats and water distribution systems, including dental unit waterlines (DUWLs). We investigated the prevalence of P. aeruginosa in DUWLs from private dental settings. We also analyzed the relationship between P. aeruginosa contamination and the presence of Legionella spp. and total viable count (TVC) in order to suggest a simple and inexpensive protocol to test the quality of water from DUWLs. We detected and quantified P. aeruginosa both by culture and by a PMA (propidium monoazide)-qPCR method. Overall, we detected P. aeruginosa in 17 samples using the PMA-qPCR and in 11 samples using the culture. All culture-positive samples were positive with the PMA-qPCR too, with an agreement between the two methods of 93% and a Cohen's kappa coefficient of κ = 0.747 (good concordance). Comparing results with results of our previous study, we noted that (a) P. aeruginosa was isolated only from DUWLs with high TVC and (b) five out of six Legionella-positive samples were negative for Pseudomonas spp. Our final suggestion is that the cleanliness of DUWLs should be assessed by TVC because it is a good indicator of the presence of pathogens such as Legionella spp. and P. aeruginosa.
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Affiliation(s)
- Savina Ditommaso
- Department of Public Health and Pediatrics, University of Turin, Piazza Polonia 94, 10126 Turin, Italy E-mail:
| | - Monica Giacomuzzi
- Department of Public Health and Pediatrics, University of Turin, Piazza Polonia 94, 10126 Turin, Italy E-mail:
| | - Elisa Ricciardi
- Department of Public Health and Pediatrics, University of Turin, Piazza Polonia 94, 10126 Turin, Italy E-mail:
| | - Gabriele Memoli
- Department of Public Health and Pediatrics, University of Turin, Piazza Polonia 94, 10126 Turin, Italy E-mail:
| | - Carla M Zotti
- Department of Public Health and Pediatrics, University of Turin, Piazza Polonia 94, 10126 Turin, Italy E-mail:
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17
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Spagnolo AM, Sartini M, Cave DD, Casini B, Tuvo B, Cristina ML. Evaluation of Microbiological and Free-Living Protozoa Contamination in Dental Unit Waterlines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152648. [PMID: 31344972 PMCID: PMC6696308 DOI: 10.3390/ijerph16152648] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022]
Abstract
Studies conducted over the last 40 years have demonstrated that the water output from dental unit waterlines (DUWLs) is often contaminated with high densities of microorganisms. It has been monitored the microbiological quality of the water in 30 public dental facilities in northern Italy in order to assess the health risk for patients and dental staff. In each facility, samples of water both from taps and from DUWLs were analyzed in order to evaluate heterotrophic plate counts (HPCs) at 22 °C and 36 °C, and to detect coliform bacteria, Pseudomonas aeruginosa, Legionella pneumophila and amoebae. In 100% of the samples taken from the DUWLs, the concentration of HPCs was above the threshold as determined by the Ministère de la Santé et des Solidarités (2007). The concentration of P. aeruginosa was greater than the indicated threshold in 16.67% of the hand-pieces analyzed. A total of 78.33% of samples were contaminated by L. pneumophila, while in the samples taken from the DUWLs alone, this percentage rose to 86.67%. Amoebae were detected in 60% of the samples taken from hand-pieces; all belonging to the species V. vermiformis. This study documented the presence of various microorganisms, including Legionella spp., at considerably higher concentrations in water samples from DUWLs than in samples of tap water in the same facilities, confirming the role of the internal DUWLs in increasing microbial contamination, especially in the absence of proper management of waterborne health risks.
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Affiliation(s)
- Anna Maria Spagnolo
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy
| | - Marina Sartini
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy.
| | - David Di Cave
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Benedetta Tuvo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy
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18
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Lizzadro J, Mazzotta M, Girolamini L, Dormi A, Pellati T, Cristino S. Comparison between Two Types of Dental Unit Waterlines: How Evaluation of Microbiological Contamination Can Support Risk Containment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E328. [PMID: 30682855 PMCID: PMC6388184 DOI: 10.3390/ijerph16030328] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 01/16/2023]
Abstract
Infection risk management in a dental unit waterline (DUWL) involves healthcare personnel and patients and is related to routine exposure to water and aerosols that may contain bacterial species. To improve water safety plans, maintenance, and sanitation procedures, analyses of heterotrophic plate counts (HPCs) at 36 °C, and two other microorganisms frequently associated with biofilms, Pseudomonas aeruginosa and Legionella spp., were performed in order to evaluate differences in microbiological contamination between two types of DUWLs: Type A, provided by a water tank, and Type B, directly connected to municipal water. The data showed that the water supply and water safety plan differentially influenced microbiological contamination: Type A DUWLs were more contaminated than Type B DUWLs for all microbiological parameters tested, with significant changes in the percentage of positive samples and contamination levels that were beyond the limits of standard guidelines. The results obtained show how the storage tank, the absence of anti-retraction valves, and the disinfection procedures performed are the main critical points of Type A DUWLs, which confirms that dental unit management (maintenance/sanitization) is often missed or not correctly applied by stakeholders, with an underestimation of the real risk of infection for patients and operators.
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Affiliation(s)
- Jessica Lizzadro
- Department of Biological, Geological, and Environmental Sciences, BiGeA, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, BiGeA, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, BiGeA, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
| | - Ada Dormi
- Department of Medical and Surgical Science, DIMEC, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
| | - Tiziana Pellati
- GVM Care & Research, via Emaldi 10, 48124 Lugo di Ravenna, Italy.
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, BiGeA, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
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19
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Sterilisation in Dentistry: A Review of the Literature. Int J Dent 2019; 2019:6507286. [PMID: 30774663 PMCID: PMC6350571 DOI: 10.1155/2019/6507286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/03/2018] [Accepted: 12/25/2018] [Indexed: 11/18/2022] Open
Abstract
In a small and medium-sized dental facility, the correct management of the sterilisation and presterilisation phases plays a fundamental role in good management of instruments and personnel, in order to ensure conditions that are more efficient with less down time. Nowadays, instrument sterilizers are increasingly efficient in achieving results, both in terms of time and size, and ensure that materials are sterile and ready to be stocked in a reasonable time. A literature search for articles related to revision work was performed using electronic databases such as PubMed, Scopus, and Google Scholar. The following keywords have been entered in the previously mentioned databases: sterilisation instruments; dental autoclave; precleaning; instruments disinfectants. The records obtained were screened by three reviewers, and only relevant articles were read full text. In addition, the timings of dental and sterilisation procedures were measured, and from these, suggestions are made in order to improve the efficiency of instrumentation management (facility used as study subject: University Dental Clinic, University of Foggia) as a function of the health-care interventions. We arrived at the conclusion that without doubt, sterilisation of instruments and products plays a fundamental role, but the efficiency of the sterilisation and presterilisation procedures cannot be separated from managing the personnel in charge by giving them specific and precise tasks.
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20
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Ji XY, Fei CN, Zhang Y, Liu J, Liu H, Song J. Three key factors influencing the bacterial contamination of dental unit waterlines: a 6-year survey from 2012 to 2017. Int Dent J 2018; 69:192-199. [PMID: 30565215 DOI: 10.1111/idj.12456] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The contaminated output water from dental unit waterlines (DUWLs) is a potential risk to both patients and dental personnel who are frequently exposed to this water or aerosols. AIM The purpose was to evaluate the contamination level and prevalence of bacteria in the output water of DUWLs, and to identify key factors to provide technical support for formulating relevant policies. METHODS We developed a special sampling connector designed for collecting dental handpiece output water and a measurement device to assess retraction of a dental chair unit (DCU). Output water from dental handpieces and air/water syringes were collected as representative of DUWLs. Water samples were tested with reference to China's national standard. FINDINGS From 2012 to 2017, 318 DCUs were randomly selected from 64 hospitals in Tianjin, China. Of these DCUs, 78.93% had no disinfection to prevent DUWL contamination. Three-hundred and forty-three (56.14%) samples complied with the guidelines on DUWL output water. The highest concentration of bacteria was 1.8 × 106 colony-forming units (CFUs)/mL. The three key factors of influence were as follows: daily or weekly disinfection of DUWLs; water supply source being hospital self-made purified water or purchased purified bottled water; and DCU with a valid anti-retraction valve. Potential infectious agents, including Bacillus cereus, Burkholderia cepacia and Pseudomonas aeruginosa, were isolated. CONCLUSION There was a high rate of contamination in DUWLs. This highlights the need to develop national standards. There is a need to disinfect the DUWLs periodically and use a cleaner source of water; more attention should be paid to the efficacy of DCU anti-retraction valves.
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Affiliation(s)
- Xue-Yue Ji
- Department of Infectious Disease, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Chun-Nan Fei
- Department of Infectious Disease, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Ying Zhang
- Department of Infectious Disease, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Jun Liu
- Department of Infectious Disease, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - He Liu
- Department of Infectious Disease, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Jia Song
- Department of Infectious Disease, Tianjin Centers for Disease Control and Prevention, Tianjin, China
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21
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Lal B, Ravindra K, Biswal M. Appraisal of microbial contamination of dental unit water systems and practices of general dental practitioners for risk reduction. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:33566-33572. [PMID: 30269279 DOI: 10.1007/s11356-018-3298-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
The study aims to evaluate the microbial contamination in dental unit water system (DUWS) in Chandigarh, India, including knowledge, attitude, and practices of general dental practitioners (GDPs) to reduce the microbiological risks of DUWS. Microbiological risks were assessed by collecting water samples from 18 dental chair units including three main water supply units. Total of 44 water samples were examined for bacteriological contamination and the highest microbial contamination was observed in the ultrasound scalers having a range of 100 to 12,000 CFU/ml, with a median count of 950 CFU/ml. Only 2.3% of the water samples met the European Union recommendation of less than 100 CFU/ml, whereas 97.7% of the water samples have the total bacterial count exceeding 100 CFU/ml. In comparison to Center for Disease Control (CDC) guidelines, only 20.5% water samples fall within the recommended quality of drinking water (less than 500 CFU/ml), and the rest of the samples (79.5%) exceed the total bacteria count with a median count of 1100 CFU/ml. Acinetobacter species, Pseudomonas aeruginosa, and Sphingomonas paucimobilis were found in most of the water samples from DUWS. Dental chair units show higher microbial load and hence failed to meet any international guidelines, e.g., CDC. The highest microbial contamination was observed in ultrasound scaler and air/water syringe outlets. Hence, the study demand for Indian guidelines for the type of water used in DUWS water and urges for the proper training of GDPs to avoid further risks to the dental patients.
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Affiliation(s)
- Bajrang Lal
- School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Khaiwal Ravindra
- School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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22
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Volgenant CMC, de Soet JJ. Cross-transmission in the Dental Office: Does This Make You Ill? CURRENT ORAL HEALTH REPORTS 2018; 5:221-228. [PMID: 30524929 PMCID: PMC6244620 DOI: 10.1007/s40496-018-0201-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Recently, numerous scientific publications were published which shed new light on the possible risks of infection for dental healthcare workers and their patients. This review aimed to provide the latest insights in the relative risks of transmission of (pathogenic) micro-organisms in the dental office. RECENT FINDINGS Of all different routes of micro-organism transmission during or immediately after dental treatment (via direct contact/via blood-blood contact/via dental unit water and aerosols), evidence of transmission is available. However, the recent results put the risks in perspective; infections related to the dental office are most likely when infection control measures are not followed meticulously. SUMMARY The risk for transmission of pathogens in a dental office resulting in an infectious disease is still unknown; it seems to be limited in developed countries but it cannot be considered negligible. Therefore, maintaining high standards of infection preventive measures is of high importance for dental healthcare workers to avoid infectious diseases due to cross-contamination.
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Affiliation(s)
- C. M. C. Volgenant
- Department of Preventive Dentistry, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
- Department of Oral Kinesiology, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J. J. de Soet
- Department of Preventive Dentistry, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
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23
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Costa D, Bossard V, Brunet K, Fradin B, Imbert C. Planktonic free-living amoebae susceptibility to dental unit waterlines disinfectants. Pathog Dis 2017; 75:4082732. [PMID: 28911034 DOI: 10.1093/femspd/ftx099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 08/10/2017] [Indexed: 12/17/2022] Open
Abstract
A high diversity of microorganisms is encountered inside dental unit waterlines (DUWL). Among those the presence of free-living amoebae (FLA) appears currently underestimated, although human infections may occur due to contact with FLA-contaminated water during dental cares. In order to limit microbial DUWL contamination, disinfectants are provided by dental unit manufacturer, however, with limited documentation on their activities against FLA. The aim of this study was to evaluate the efficiency of three commercial DUWL disinfectants: the Calbenium© (Airel, Champigny-sur-Marne, France), the Oxygenal 6© (Kavo, Biberach, Germany) and the Sterispray© (Gammasonic, Billom, France), against two FLA species, i.e. Acanthamoeba castellanii and Vermamoeba vermiformis alone or co-cultured with Pseudomonas aeruginosa and Candida albicans at concentrations ranging from 0% to 5% (v/v). Results showed varied efficacies of disinfectants: the Oxygenal 6© did not exhibit FLA killing activity, while the Sterispray© and the Calbenium© displayed concentration- and species-dependent activities with a maximum eradication rates of 100% and 86%, and 79% and 97% for A. castellani and V. vermiformis, respectively. None of the disinfectants were able to totally eradicate FLA at concentrations recommended by manufacturers. Present results highlight unsatisfactory anti-FLA activities of 3 DUWL disinfectant preparations advocating deeper investigation of antimicrobial spectra of commercial disinfectants in use for DUWL maintenance.
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Affiliation(s)
- Damien Costa
- UMR CNRS 7267, Laboratory of Ecology and Biology of Interactions, Faculty of Medecine and Pharmacy, University of Poitiers, Bat D1, 6 rue de la Milétrie, TSA 51115, 86073 Poitiers Cedex 9, France
| | - Valentin Bossard
- UMR CNRS 7267, Laboratory of Ecology and Biology of Interactions, Faculty of Medecine and Pharmacy, University of Poitiers, Bat D1, 6 rue de la Milétrie, TSA 51115, 86073 Poitiers Cedex 9, France
| | - Kévin Brunet
- UMR CNRS 7267, Laboratory of Ecology and Biology of Interactions, Faculty of Medecine and Pharmacy, University of Poitiers, Bat D1, 6 rue de la Milétrie, TSA 51115, 86073 Poitiers Cedex 9, France
| | - Benjamin Fradin
- UMR CNRS 7267, Laboratory of Ecology and Biology of Interactions, Faculty of Medecine and Pharmacy, University of Poitiers, Bat D1, 6 rue de la Milétrie, TSA 51115, 86073 Poitiers Cedex 9, France
| | - Christine Imbert
- UMR CNRS 7267, Laboratory of Ecology and Biology of Interactions, Faculty of Medecine and Pharmacy, University of Poitiers, Bat D1, 6 rue de la Milétrie, TSA 51115, 86073 Poitiers Cedex 9, France
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Pankhurst CL, Scully C, Samaranayake L. Dental Unit Water Lines and their Disinfection and Management: A Review. ACTA ACUST UNITED AC 2017; 44:284-5, 289-92. [PMID: 29172350 DOI: 10.12968/denu.2017.44.4.284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The perceived threat to public health from dental unit water line (DUWL) contamination comes from opportunistic and respiratory pathogens such as Legionella spp, Nontuberculous Mycobacteria (NTM) and pseudomonads. These organisms can grow and multiply in the DUWL biofilm to reach infective concentrations, with the potential for inhalation leading to respiratory infections or direct contamination of surgical wounds. In this paper we discuss current legislation and practical methods for delivering water within the DUWL that meets the standards for safety. Clinical relevance: Understanding the clinical relevance and methods for decontaminating DUWL is essential to create a safe working environment in dentistry.
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Zemouri C, de Soet H, Crielaard W, Laheij A. A scoping review on bio-aerosols in healthcare and the dental environment. PLoS One 2017; 12:e0178007. [PMID: 28531183 PMCID: PMC5439730 DOI: 10.1371/journal.pone.0178007] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/06/2017] [Indexed: 01/16/2023] Open
Abstract
Background Bio-aerosols originate from different sources and their potentially pathogenic nature may form a hazard to healthcare workers and patients. So far no extensive review on existing evidence regarding bio-aerosols is available. Objectives This study aimed to review evidence on bio-aerosols in healthcare and the dental setting. The objectives were 1) What are the sources that generate bio-aerosols?; 2) What is the microbial load and composition of bio-aerosols and how were they measured?; and 3) What is the hazard posed by pathogenic micro-organisms transported via the aerosol route of transmission? Methods Systematic scoping review design. Searched in PubMed and EMBASE from inception to 09-03-2016. References were screened and selected based on abstract and full text according to eligibility criteria. Full text articles were assessed for inclusion and summarized. The results are presented in three separate objectives and summarized for an overview of evidence. Results The search yielded 5,823 studies, of which 62 were included. Dental hand pieces were found to generate aerosols in the dental settings. Another 30 sources from human activities, interventions and daily cleaning performances in the hospital also generate aerosols. Fifty-five bacterial species, 45 fungi genera and ten viruses were identified in a hospital setting and 16 bacterial and 23 fungal species in the dental environment. Patients with certain risk factors had a higher chance to acquire Legionella in hospitals. Such infections can lead to irreversible septic shock and death. Only a few studies found that bio-aerosol generating procedures resulted in transmission of infectious diseases or allergic reactions. Conclusion Bio-aerosols are generated via multiple sources such as different interventions, instruments and human activity. Bio-aerosols compositions reported are heterogeneous in their microbiological composition dependent on the setting and methodology. Legionella species were found to be a bio-aerosol dependent hazard to elderly and patients with respiratory complaints. But all aerosols can be can be hazardous to both patients and healthcare workers.
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Affiliation(s)
- Charifa Zemouri
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Hans de Soet
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wim Crielaard
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexa Laheij
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Estrich CG, Gruninger SE, Lipman RD. Rates and predictors of exposure to Legionella pneumophila in the United States among dental practitioners: 2002 through 2012. J Am Dent Assoc 2017; 148:164-171. [PMID: 28126227 DOI: 10.1016/j.adaj.2016.11.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND In this study, the authors compared the odds of exposure to Legionella pneumophila among currently active dental practitioners with that of nonpractitioners and evaluated demographic and clinical practice predictors of exposure. METHODS The authors obtained demographic characteristics and dental practice behaviors from participants in the annual American Dental Association Health Screening Program survey administered from 2002 through 2012. The authors assayed serum samples obtained from participants for L pneumophila antibodies. The authors used an adjusted logit model to evaluate predictors of positive results. RESULTS Among 5,431 participants, approximately 10% were positive for L pneumophila, with no significant differences between dental practitioners and nonpractitioners. Geographic location was the only significant predictor of seropositivity, with no increased risk of being exposed to L pneumophila associated with age, race, sex, years in practice, hours of practice per week, use of barrier protection, or infection control practices. CONCLUSIONS Prevalence of L pneumophila antibodies was 10.4% among dental and nondental personnel. US Census division was the only significant predictor of seropositivity. The authors conclude that provision of dental care did not increase the risk of being exposed to Legionella. PRACTICAL IMPLICATIONS Dentists should be aware of the prevalence of Legionella species in their practice areas to understand their personal risk of developing an infection.
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Schönning C, Jernberg C, Klingenberg D, Andersson S, Pääjärvi A, Alm E, Tano E, Lytsy B. Legionellosis acquired through a dental unit: a case study. J Hosp Infect 2017; 96:89-92. [PMID: 28228245 DOI: 10.1016/j.jhin.2017.01.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
In 2012, an elderly immunocompromised man died from legionellosis at a hospital in Uppsala, Sweden. The patient had visited a dental ward at the hospital during the incubation period. Legionella spp. at a concentration of 2000 colony-forming units/L were isolated from the cupfiller outlet providing water for oral rinsing. Isolates from the patient and the dental unit were Legionella pneumophila serogroup 1, subgroup Knoxville and ST9. Pulsed-field gel electrophoresis and whole-genome sequencing strongly suggested that the isolates were of common origin. This report presents one of few documented cases of legionellosis acquired through a dental unit.
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Affiliation(s)
- C Schönning
- Department of Surveillance and Coordination, Public Health Agency of Sweden, Sweden.
| | - C Jernberg
- Department of Microbiology, Public Health Agency of Sweden, Sweden
| | - D Klingenberg
- Department of Microbiology, Public Health Agency of Sweden, Sweden
| | - S Andersson
- Department of Microbiology, Public Health Agency of Sweden, Sweden
| | - A Pääjärvi
- Department of Microbiology, Public Health Agency of Sweden, Sweden
| | - E Alm
- Department of Microbiology, Public Health Agency of Sweden, Sweden
| | - E Tano
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Sweden
| | - B Lytsy
- Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University, Sweden
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Ji XY, Fei CN, Zhang Y, Zhang W, Liu J, Dong J. Evaluation of bacterial contamination of dental unit waterlines and use of a newly designed measurement device to assess retraction of a dental chair unit. Int Dent J 2016; 66:208-14. [PMID: 27000421 DOI: 10.1111/idj.12225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Dental unit waterline (DUWL) output water is delivered through instruments of a dental chair unit (DCU) to irrigate and cool teeth. However, these waterlines can be heavily contaminated with bacteria. AIM The purpose of the present study was to assess retraction and investigate the contamination level and prevalence of bacteria in DUWL output water. METHODS Fifty-eight DCUs were randomly selected from 30 hospitals in 10 districts of Tianjin, one of the four special municipalities of China. A unique sampling connector was used in place of the dental handpiece to collect water samples. Evaluation of retraction was accomplished using a retraction measurement device designed in accordance with the International Standard ISO 7494-2:2015(E). RESULTS A total of 263 water samples were collected, and the highest concentration of bacteria [1.8 × 10(6) colony-forming units (CFU)/mL] was found in the handpiece group. Thirty (51.72%) water samples in the handpiece group and 21 (36.21%) in the air/water syringe groups were cultured, yielding colony counts of > 500 CFU/mL. Potential infectious agents, such as Bacillus cereus, Kocuria kristinae and Pseudomonas fluorescens, were isolated from the water samples. Thirty (51.72%) DCUs failed the retraction evaluation. There was a significant, positive correlation (P < 0.05) between the concentration of bacteria in the water sample and the retracted volume. CONCLUSION It is of paramount importance to increase compliance with the standards for controlling DUWL contamination. Routine microbial monitoring and evaluation of retraction are necessary to provide high-quality water for use in dental treatment.
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Affiliation(s)
- Xue-Yue Ji
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Chun-Nan Fei
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Ying Zhang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Wei Zhang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Jun Liu
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Jie Dong
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
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The efficacy of disinfectants in the decontamination of dental unit water lines: an in vitro laboratory study. BDJ Open 2016; 2:16003. [PMID: 29607064 PMCID: PMC5842839 DOI: 10.1038/bdjopen.2016.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/15/2015] [Accepted: 01/18/2016] [Indexed: 11/24/2022] Open
Abstract
Objectives/Aims: This in vitro laboratory study compared the efficacy of water, sodium percarbonate (SPC) and chlorine dioxide (ClO2) solutions in the disinfection of dental unit water lines (DUWLs). Materials and Methods: New DUWL tubes were cut, split open, and mono-culture and mixed-culture biofilms of Staphylococcus aureus, Enterococcus faecalis and Streptococcus mutans were grown. Harvested biofilms from the sectioned DUWL tubes were exposed to sterile distilled water, SPC or 5 and 10 p.p.m. ClO2 in both a stationary phase and through a constant flow. Bacterial counts were compared using the Kruskal–Wallis nonparametric rank test. Results: In the mono-culture biofilms, SPC, 5 and 10 p.p.m. ClO2 significantly reduced all the test organisms (P<0.01). However, no significant difference was found between SPC and ClO2. In the mixed-culture biofilms exposed to disinfectant without flow, ClO2 significantly reduced the biofilm (P=0.02) compared with water and SPC. Similarly, in the constant flow study, ClO2 proved to be superior to water. Conclusion: At low concentrations, ClO2 with and without flow significantly reduced the mixed-culture biofilm grown in vitro on the sections of the DUWL tubes. Therefore, it has the potential to be used in the patient treatment water, as it is potable at these concentrations, and to decontaminate and limit the biofilm formation in the water lines.
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Pseudomonas aeruginosa and Achromobacter sp. clonal selection leads to successive waves of contamination of water in dental care units. Appl Environ Microbiol 2015; 81:7509-24. [PMID: 26296724 DOI: 10.1128/aem.01279-15] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/12/2015] [Indexed: 01/30/2023] Open
Abstract
Dental care unit waterlines (DCUWs) consist of complex networks of thin tubes that facilitate the formation of microbial biofilms. Due to the predilection toward a wet environment, strong adhesion, biofilm formation, and resistance to biocides, Pseudomonas aeruginosa, a major human opportunistic pathogen, is adapted to DCUW colonization. Other nonfermentative Gram-negative bacilli, such as members of the genus Achromobacter, are emerging pathogens found in water networks. We reported the 6.5-year dynamics of bacterial contamination of waterlines in a dental health care center with 61 dental care units (DCUs) connected to the same water supply system. The conditions allowed the selection and the emergence of clones of Achromobacter sp. and P. aeruginosa characterized by multilocus sequence typing, multiplex repetitive elements-based PCR, and restriction fragment length polymorphism in pulsed-field gel electrophoresis, biofilm formation, and antimicrobial susceptibility. One clone of P. aeruginosa and 2 clones of Achromobacter sp. colonized successively all of the DCUWs: the last colonization by P. aeruginosa ST309 led to the closing of the dental care center. Successive dominance of species and clones was linked to biocide treatments. Achromobacter strains were weak biofilm producers compared to P. aeruginosa ST309, but the coculture of P. aeruginosa and Achromobacter enhanced P. aeruginosa ST309 biofilm formation. Intraclonal genomic microevolution was observed in the isolates of P. aeruginosa ST309 collected chronologically and in Achromobacter sp. clone A. The contamination control was achieved by a complete reorganization of the dental health care center by removing the connecting tubes between DCUs.
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Retana-Moreira L, Abrahams-Sandí E, Castro-Artavia E, Fernández-Sánchez A, Castro-Castillo A, Reyes-Batlle M, Lorenzo-Morales J. Isolation and Molecular Characterization of Acanthamoeba
Strains from Dental Units in Costa Rica. J Eukaryot Microbiol 2015; 62:733-6. [DOI: 10.1111/jeu.12229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Lissette Retana-Moreira
- Department of Parasitology; Faculty of Microbiology; University of Costa Rica; San Pedro San José Costa Rica
- Centro de Investigación en Enfermedades Tropicales; University of Costa Rica; San Pedro San José Costa Rica
| | - Elizabeth Abrahams-Sandí
- Department of Parasitology; Faculty of Microbiology; University of Costa Rica; San Pedro San José Costa Rica
- Centro de Investigación en Enfermedades Tropicales; University of Costa Rica; San Pedro San José Costa Rica
| | - Esteban Castro-Artavia
- Department of Parasitology; Faculty of Microbiology; University of Costa Rica; San Pedro San José Costa Rica
| | - Ana Fernández-Sánchez
- Department of Parasitology; Faculty of Microbiology; University of Costa Rica; San Pedro San José Costa Rica
- Centro de Investigación en Enfermedades Tropicales; University of Costa Rica; San Pedro San José Costa Rica
| | - Alfredo Castro-Castillo
- Department of Parasitology; Faculty of Microbiology; University of Costa Rica; San Pedro San José Costa Rica
- Centro de Investigación en Enfermedades Tropicales; University of Costa Rica; San Pedro San José Costa Rica
| | - María Reyes-Batlle
- Institute of Tropical Diseases and Public Health of the Canary Islands; University of La Laguna; Tenerife Spain
| | - Jacob Lorenzo-Morales
- Institute of Tropical Diseases and Public Health of the Canary Islands; University of La Laguna; Tenerife Spain
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Petti S, Polimeni A. The Rationale of Guidelines for Infection Control in Dentistry: Precautionary Principle or Acceptable Risk? Infect Control Hosp Epidemiol 2015; 31:1308-10. [DOI: 10.1086/657581] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Holy O, Matouskova I, Juraskova E. Risk of hospital-acquired Legionellosis from microbial contamination of potable water at a Bone Marrow Transplant Unit in a Czech University Hospital. J WATER CHEM TECHNO+ 2014. [DOI: 10.3103/s1063455x14050087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lal S, Singhrao SK, Bricknell M, Pearce M, Morton LHG, Ahmed W, Crean SJ. Monitoring Dental-Unit-Water-Line Output Water by Current In-office Test Kits. Curr Microbiol 2014; 69:135-42. [DOI: 10.1007/s00284-014-0569-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
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Meriem L, Hafida H, Kaotar N, Samia B, Imene M, Ibtissem KT, Mohammed T. Detection of biofilm formation, icaADBC gene and investigation of toxin genes in Staphylococus spp. strain from dental unit waterlines, University Hospital Center (UHC) Tlemcen Algeria. ACTA ACUST UNITED AC 2014. [DOI: 10.5897/ajmr2013.6101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Petti S, Moroni C, Messano GA, Polimeni A. Detection of oral streptococci in dental unit water lines after therapy with air turbine handpiece: biological fluid retraction more frequent than expected. Future Microbiol 2013; 8:413-21. [PMID: 23464376 DOI: 10.2217/fmb.12.151] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Oral streptococci detected in water from dental unit water lines (DUWLs) are a surrogate marker of patients' biological fluid retraction during therapy. We investigated oral streptococci detection rate in DUWLs in a representative sample of private offices in real-life conditions. MATERIALS & METHODS Samples of nondisinfected water (100 ml) were collected from the DUWL designated for the air turbine handpiece in 81 dental units, immediately after dental treatment of patients with extensive air turbine handpiece use. Water was filtered and plated on a selective medium for oral streptococci and, morphologically, typical colonies of oral streptococci were counted. The lowest detection limit was 0.01 CFU/ml. RESULTS The oral streptococci detection rate was 72% (95% CI: 62-81%), with a mean level of 0.7 CFU/ml. Oral streptococci detection was not affected by handpiece age or dental treatment type, but was associated with dental unit age. CONCLUSION Biological fluid retraction into DUWLs during patient treatment and, possibly, the risk for patient-to-patient blood- or air-borne pathogen transmission are more frequent than expected.
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Affiliation(s)
- Stefano Petti
- Department of Public Health & Infectious Diseases, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy.
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Szymańska J, Sitkowska J. Opportunistic bacteria in dental unit waterlines: assessment and characteristics. Future Microbiol 2013; 8:681-9. [PMID: 23642121 DOI: 10.2217/fmb.13.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM The study aimed to determine qualitative and quantitative contamination of dental unit reservoir water with aerobic and facultative anaerobic bacteria, with regards to health risk to dental staff and patients. MATERIALS & METHODS The study material included water samples from 107 unit reservoirs. Conventional microbiological methods were used. The isolated bacteria were divided into three groups according to pathogenic mechanisms. RESULTS Dental unit water contamination was widespread. The isolated bacteria average concentration was 1.1 × 10(5) CFU/ml, with Ralstonia pickettii as the prevailing species (49.33%). The total potentially pathogenic bacteria were 54.54% of all the isolated bacteria. Bacteria causing infectious and invasive diseases constituted over one-half of this group, while allergizing and immunotoxic bacteria occurred in smaller quantities. CONCLUSION The presence of over 50% potentially pathogenic microorganisms among the isolated bacteria and their very high concentrations call for the daily use of effective methods to reduce dental unit water contamination and health risk.
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Affiliation(s)
- Jolanta Szymańska
- Department of Paedodontics, Medical University of Lublin, Karmelicka 7, 20-018 Lublin, Poland.
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Szymańska J, Sitkowska J. Bacterial contamination of dental unit waterlines. ENVIRONMENTAL MONITORING AND ASSESSMENT 2013; 185:3603-3611. [PMID: 22899458 PMCID: PMC3613572 DOI: 10.1007/s10661-012-2812-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 07/25/2012] [Indexed: 06/01/2023]
Abstract
Safety of patients and dental personnel requires the appropriate microbiological water quality in dental units. During treatment, patients and dental workers are exposed both to direct contact with bacteria-contaminated water in the form of splatter and with contaminated water aerosol emitted during work by unit handpieces, including rotating and ultrasonic instruments. The aim of the study was to determine the qualitative and quantitative contamination of water in dental unit reservoirs with aerobic and facultative anaerobic bacteria. The study material included water sampled from 107 dental unit reservoirs located in dental surgeries of public health centres. Conventional microbiological methods were used to identify microorganisms. The study shows that the contamination of water in dental unit reservoirs with aerobic and facultative anaerobic bacteria is commonplace. The mean concentration of mesophile bacteria in dental unit reservoir water exceeded 1.1 × 10(5) cfu/ml. The prevailing species were Gram-negative bacteria of the families Burkholderiaceae, Pseudomonadaceae, Ralstoniaceae and Sphingomonadaceae. The most numerous bacteria were Ralstonia pickettii, constituting 49.33 % of all the identified aerobic and facultative anaerobic bacteria. Among Gram-positive rods, the most numerous were bacteria of the genus Brevibacterium (5.83 %), while the highest percentage shares (13.25 %) of all Gram-positive microorganisms were found for Actinomyces spp. The study confirms the necessity of regular monitoring of microbial contamination of dental unit waterlines (DUWL) and use of various water treatment procedures available to disinfect DWUL.
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Affiliation(s)
- Jolanta Szymańska
- Chair and Department of Paedodontics, Medical University, Karmelicka 7, 20-018 Lublin, Poland.
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Barker CS, Soro V, Dymock D, Sandy JR, Ireland AJ. Microbial contamination of “as received” and “clinic exposed” orthodontic materials. Am J Orthod Dentofacial Orthop 2013; 143:317-23. [DOI: 10.1016/j.ajodo.2012.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 09/01/2012] [Accepted: 09/01/2012] [Indexed: 11/30/2022]
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Garg SK, Mittal S, Kaur P. Dental unit waterline management: historical perspectives and current trends. ACTA ACUST UNITED AC 2012; 3:247-52. [DOI: 10.1111/j.2041-1626.2012.00135.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 02/19/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Shushant K. Garg
- Maharishi Markandeshwar College of Dental Sciences and Research; Mullana-Ambala Haryana India
| | - Sanjeev Mittal
- Maharishi Markandeshwar College of Dental Sciences and Research; Mullana-Ambala Haryana India
| | - Prabhmanik Kaur
- Maharishi Markandeshwar College of Dental Sciences and Research; Mullana-Ambala Haryana India
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Murthy BS, Manjula K, George JV, Shruthi N. Evaluation of effect of three different dental unit waterline antimicrobials on the shear bond strength to dentin - An ex vivo study. J Conserv Dent 2012; 15:289-92. [PMID: 22876021 PMCID: PMC3410344 DOI: 10.4103/0972-0707.97963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 11/14/2011] [Accepted: 01/13/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In restorative treatment dental unit water is used while irrigating the cavity and also in the use of composite restorations to flush away the etchant to place bonding agent. These antimicrobials may influence the bond strength of the dentine bonding agent to the dentine. AIM AND OBJECTIVE To evaluate the effect of three different dental units waterline antimicrobials on the shear bond strength of dentin. MATERIALS AND METHODS Sixty freshly extracted human teeth were taken and the occlusal surfaces were sectioned to obtain a flat dentin surface. Then the teeth were randomized into 4 groups depending on the antimicrobial used: Group 1(Distilled water), Group 2 (Alpron), Group 3 (CitriSil), and Group 4 (Chlorhexidine). The dentine surface was prepared for bonding and composite resin was placed in two increments of 2 mm each. The specimens were stored in distilled water, thermo cycled after 7 days shear test was performed by using the universal testing machine. RESULT No significant difference between Group 1 and Group 2 with regard to shear bond strength. There was a significant difference in the SBS of Group 1 and Group 3 and Group 4. The SBS of group 2 was higher than Group 3 and Group 4 and the difference was statistically significant. CONCLUSION Citrisil and Chlorhexidine groups showed affected bond strength whereas Alpron did not vary with bond strength.
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Affiliation(s)
- Bv Sreenivasa Murthy
- Department of Conservative Dentistry and Endodontics, M.S. Ramaiah Dental College and Hospital, M.S. Ramaiah Nagar, MSRIT Post, Bangalore, Karnataka, India
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Leduc A, Gravel S, Abikhzer J, Roy S, Barbeau J. Polymerase chain reaction detection of potentially pathogenic free-living amoebae in dental units. Can J Microbiol 2012; 58:884-6. [PMID: 22716087 DOI: 10.1139/w2012-071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Several genera of amoebae can be found in water from dental units and on the inner surface of waterlines. The presence of bacterial biofilms on these surfaces is thought to favor the proliferation of amoebae. Potentially pathogenic Acanthamoeba and Naegleria spp. may be an infection risk for patients through contact with open surgical sites or aerosolization. A polymerase chain reaction of DNA extracted from pelleted samples showed that Acanthamoeba spp. and Naegleria spp. were present in water from dental units, suction lines, and suction filters at the dental clinic of the Université de Montréal. Acanthamoeba spp. were detected in 24.2% of 66 samples and Naegleria spp. in 3.0%. We discuss the infection risk associated with these results.
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Affiliation(s)
- Annie Leduc
- Faculté de médecine dentaire, Université de Montréal, QC, Canada
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Corrao CRN, Mazzotta A, La Torre G, De Giusti M. Biological risk and occupational health. INDUSTRIAL HEALTH 2012; 50:326-337. [PMID: 22785422 DOI: 10.2486/indhealth.ms1324] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Many work activities include hazards to workers, and among these biological risk is particularly important, mostly because of different types of exposure, contact with highly dangerous agents, lack of limit values able to compare all exposures, presence of workers with defective immune systems and therefore more susceptible to the risk. Bioaerosols and dust are considered important vehicles of microganisms at workplaces and interaction with other occupational agents is assumed. Moreover, biological risk can be significant in countries with increasing economic development or particular habits and some biological agents are also classified as carcinogenic to human. Specific emerging biological risks have been recently pointed out by Risk Observatory of the European Agency for Safety and Health at work, and we must consider the worker's attitude and behaviour, influenced by his own perception of risk more than his real knowledge, that could over-underestimate the risk itself. Therefore, biological risk at work requires a complex approach in relation to risk assessment and risk management, made more difficult due to the wide variety of biological agents, working environments and working techniques that can determine the exposures.
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Laheij AMGA, Kistler JO, Belibasakis GN, Välimaa H, de Soet JJ. Healthcare-associated viral and bacterial infections in dentistry. J Oral Microbiol 2012; 4:JOM-4-17659. [PMID: 22701774 PMCID: PMC3375115 DOI: 10.3402/jom.v4i0.17659] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 05/11/2012] [Accepted: 05/11/2012] [Indexed: 12/19/2022] Open
Abstract
Infection prevention in dentistry is an important topic that has gained more interest in recent years and guidelines for the prevention of cross-transmission are common practice in many countries. However, little is known about the real risks of cross-transmission, specifically in the dental healthcare setting. This paper evaluated the literature to determine the risk of cross-transmission and infection of viruses and bacteria that are of particular relevance in the dental practice environment. Facts from the literature on HSV, VZV, HIV, Hepatitis B, C and D viruses, Mycobacterium spp., Pseudomonas spp., Legionella spp. and multi-resistant bacteria are presented. There is evidence that Hepatitis B virus is a real threat for cross-infection in dentistry. Data for the transmission of, and infection with, other viruses or bacteria in dental practice are scarce. However, a number of cases are probably not acknowledged by patients, healthcare workers and authorities. Furthermore, cross-transmission in dentistry is under-reported in the literature. For the above reasons, the real risks of cross-transmission are likely to be higher. There is therefore a need for prospective longitudinal research in this area, to determine the real risks of cross-infection in dentistry. This will assist the adoption of effective hygiene procedures in dental practice.
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Affiliation(s)
- A M G A Laheij
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
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Bristela M, Skolka A, Schmid-Schwap M, Piehslinger E, Indra A, Wewalka G, Stauffer F. Testing for aerobic heterotrophic bacteria allows no prediction of contamination with potentially pathogenic bacteria in the output water of dental chair units. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2012; 7:Doc12. [PMID: 22558046 PMCID: PMC3334951 DOI: 10.3205/dgkh000196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Currently, to our knowledge, quality of output water of dental chair units is not covered by specific regulations in the European Union, and national recommendations are heterogeneous. In Germany, water used in dental chair units must follow drinking water quality. In the United States of America, testing for aerobic heterotrophic bacteria is recommended. The present study was performed to evaluate whether the counts of aerobic heterotrophic bacteria correlate with the presence of potentially pathogenic bacteria such as Legionella spp. or Pseudomonas aeruginosa. Methods: 71 samples were collected from 26 dental chair units with integrated disinfection device and 31 samples from 15 outlets of the water distribution pipework within the department were examined. Samples were tested for aerobic heterotrophic bacteria at 35°C and 22°C using different culture media and for Legionella spp. and for Pseudomonas aeruginosa. Additionally, strains of Legionella pneumophila serogroup 1 were typed with monoclonal antibodies and representative samples of Legionella pneumophila serogroup 1 were typed by sequence based typing. Results: Our results showed a correlation between different agars for aerobic heterotrophic bacteria but no correlation for the count of aerobic heterotrophic bacteria and the presence of Legionella spp. or Pseudomonas aeruginosa. Conclusion: Testing for aerobic heterotrophic bacteria in output water or water distribution pipework within the departments alone is without any value for predicting whether the water is contaminated with potentially pathogenic bacteria like Legionella spp. or Pseudomonas aeruginosa.
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Affiliation(s)
- Margit Bristela
- Bernhard Gottlieb University Clinic of Dentistry, Department of Fixed and Removable Prosthodontics, Medical University Vienna, Austria
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Pasquarella C, Veronesi L, Napoli C, Castiglia P, Liguori G, Rizzetto R, Torre I, Righi E, Farruggia P, Tesauro M, Torregrossa MV, Montagna MT, Colucci ME, Gallè F, Masia MD, Strohmenger L, Bergomi M, Tinteri C, Panico M, Pennino F, Cannova L, Tanzi M. Microbial environmental contamination in Italian dental clinics: A multicenter study yielding recommendations for standardized sampling methods and threshold values. THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 420:289-299. [PMID: 22335883 DOI: 10.1016/j.scitotenv.2012.01.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/06/2012] [Accepted: 01/12/2012] [Indexed: 05/31/2023]
Abstract
A microbiological environmental investigation was carried out in ten dental clinics in Italy. Microbial contamination of water, air and surfaces was assessed in each clinic during the five working days, for one week per month, for a three-month period. Water and surfaces were sampled before and after clinical activity; air was sampled before, after, and during clinical activity. A wide variation was found in microbial environmental contamination, both within the participating clinics and for the different sampling times. Before clinical activity, microbial water contamination in tap water reached 51,200cfu/mL (colony forming units per milliliter), and that in Dental Unit Water Systems (DUWSs) reached 872,000cfu/mL. After clinical activity, there was a significant decrease in the Total Viable Count (TVC) in tap water and in DUWSs. Pseudomonas aeruginosa was found in 2.38% (7/294) of tap water samples and in 20.06% (59/294) of DUWS samples; Legionella spp. was found in 29.96% (89/297) of tap water samples and 15.82% (47/297) of DUWS samples, with no significant difference between pre- and post-clinical activity. Microbial air contamination was highest during dental treatments, and decreased significantly at the end of the working activity (p<0.05). The microbial buildup on surfaces increased significantly during the working hours. This study provides data for the establishment of standardized sampling methods, and threshold values for contamination monitoring in dentistry. Some very critical situations have been observed which require urgent intervention. Furthermore, the study emphasizes the need for research aimed at defining effective managing strategies for dental clinics.
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Affiliation(s)
- Cesira Pasquarella
- Dipartimento di Sanità Pubblica, Università degli Studi di Parma, Italy.
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O’Donnell MJ, Boyle MA, Russell RJ, Coleman DC. Management of dental unit waterline biofilms in the 21st century. Future Microbiol 2011; 6:1209-26. [DOI: 10.2217/fmb.11.104] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Dental chair units (DCUs) use water to cool and irrigate DCU-supplied instruments and tooth surfaces, and provide rinsewater during dental treatment. A complex network of interconnected plastic dental unit waterlines (DUWLs) supply water to these instruments. DUWLs are universally prone to microbial biofilm contamination seeded predominantly from microorganisms in supply water. Consequently, DUWL output water invariably becomes contaminated by high densities of microorganisms, principally Gram-negative environmental bacteria including Pseudomonas aeruginosa and Legionella species, but sometimes contain human-derived pathogens such as Staphylococcus aureus. Patients and staff are exposed to microorganisms from DUWL output water and to contaminated aerosols generated by DCU instruments. A wide variety of approaches, many unsuccessful, have been proposed to control DUWL biofilm. More recently, advances in biofilm science, chemical DUWL biofilm treatment agents, DCU design, supply water treatment and development of automated DUWL biofilm control systems have provided effective long-term solutions to DUWL biofilm control.
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Affiliation(s)
- Mary J O’Donnell
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin 2, Republic of Ireland
| | - Maria A Boyle
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin 2, Republic of Ireland
| | - Ronnie J Russell
- The Department of Microbiology, The Moyne Institute of Preventive Medicine, University of Dublin, Trinity College Dublin, Dublin 2, Republic of Ireland
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D'Ovidio C, Carnevale A, Pantaleone G, Piattelli A, Di Bonaventura G. First report of an acute purulent maxillary sinusitis caused by Pseudomonas aeruginosa secondary to dental implant placement in an immunocompetent patient. Br Dent J 2011; 211:205-7. [PMID: 21904351 DOI: 10.1038/sj.bdj.2011.723] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2011] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN In this case report, we present maxillary Pseudomonas aeruginosa sinusitis in an immunocompetent patient who underwent an autologous bone transplant for the insertion of dental implants. RESULTS The infection was eradicated after removal of the dental implants and long-term antibiotic therapy. CONCLUSION Despite the infection resolution, severe complications were observed with important legal consequences.
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Affiliation(s)
- C D'Ovidio
- Department of Medicine and Aging Science, Section of Legal Medicine, 'G. d'Annunzio' University of Chieti-Pescara, Italy.
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Boyle M, O’Donnell M, Russell R, Coleman D. Lack of cytotoxicity by Trustwater Ecasol™ used to maintain good quality dental unit waterline output water in keratinocyte monolayer and reconstituted human oral epithelial tissue models. J Dent 2010; 38:930-40. [DOI: 10.1016/j.jdent.2010.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/05/2010] [Accepted: 08/06/2010] [Indexed: 11/16/2022] Open
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