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Wu M, Shi Z, Yu X, Xu Y, Jin X, Zhang L, Fu B. Disinfection methods of dental unit waterlines contamination: a systematic review. J Med Microbiol 2022; 71. [PMID: 35670283 DOI: 10.1099/jmm.0.001540] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background. Severe contamination of dental unit waterlines was found in healthcare settings. The benefits of decontamination methods are controversial. The aim of this review was to systematically evaluate disinfection methods in contamination control of dental unit waterlines.Methods. The terms 'dental unit waterline(s) or DUWL(s) or dental unit water line(s)' were searched through PubMed, Cochrane Library, Embase, Web of Science and Scopusup to 31 May 2021. The DUWLs' output water was incubated on R2A agar at 20-28 °C for 5-7 days to evaluate heterotrophic mesophilic bacteria. The risk of bias was evaluated by a modified Newcastle-Ottawa quality assessment scale.Results. Eighteen papers from the literature were included. One study indicated that water supply played a crucial role in disinfecting DUWLs. Three studies indicated that flushing decreased bacteria counts but did not meet the American CDC standard (500 c.f.u. ml-1). All chlorine- and peroxide-containing disinfectants except sodium hypochlorite in one of 15 studies as well as three mouthrinses and citrus botanical extract achieved the standard (≤500 c.f.u. ml-1). The included studies were of low (1/18), moderate (6/18) and high (11/18) quality.Conclusion. Independent water reservoirs are recommended for disinfecting DUWLs using distilled water. Flushing DUWLs should be combined with disinfections. Nearly all the chlorine-, chlorhexidine- and peroxide-containing disinfectants, mouthrinses and citrus botanical extract meet the standard for disinfecting DUWLs. Alkaline peroxide would lead to tube blockage in the DUWLs. Regularly changing disinfectants can reduce the risk of occurrence of disinfectant-resistant strains of microbes.
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Affiliation(s)
- Mengting Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, PR China
| | - Zhiwei Shi
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, PR China
| | - Xuefen Yu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, PR China
| | - Yuedan Xu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, PR China
| | - Xinyang Jin
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, PR China
| | - Ling Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, PR China
| | - Baiping Fu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, PR China
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Minoli M, Zechini G, Capparé P, Landoni G. Dental deaths in Italy as reported by online press articles. Oral Dis 2019; 26:858-864. [PMID: 31310434 DOI: 10.1111/odi.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Mortality on the dental chair is a rare and underreported event. This study aimed to identify all deaths that occurred during dental procedures in Italy. METHODS We searched PubMed/Medline, Scopus, and Internet archives looking for patients who died before, during, or after a dental procedure in Italy from 1990 to 2019. RESULTS All the 36 identified fatal events were reported by national or regional newspapers, and none was reported by scientific databases. Interestingly, no cases regarding patients ≤16 years old were found and there was no variation in the number of reported deaths over the years. Most of the cases (n = 29) occurred in out-of-hospital private dental offices. Tooth extraction represented the most frequent culprit operation (39%), while myocardial infarction (28%) was the leading cause of death, followed by cardiac arrest (25%), allergies (11%), and infections (8%). In four cases, death was preprocedural, in 10 intraprocedural and in 21 postprocedural. In 17 cases, a temporal association between injection of anesthesia/sedation and death was observed. CONCLUSION This is the first report on Italian dental procedure-related deaths. Most of these deaths were only temporally associated with a dental procedure and could not to be attributed to malpractice.
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Affiliation(s)
- Margherita Minoli
- Dental School, Vita-Salute San Raffaele University of Milan, Milano, Italy
| | - Giacomo Zechini
- Dental School, Vita-Salute San Raffaele University of Milan, Milano, Italy
| | - Paolo Capparé
- Dental School, Vita-Salute San Raffaele University of Milan, Milano, Italy.,Vita-Salute San Raffaele University of Milan, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University of Milan, Milan, Italy
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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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Petti S, Vitali M. Occupational risk for Legionella infection among dental healthcare workers: meta-analysis in occupational epidemiology. BMJ Open 2017; 7:e015374. [PMID: 28710211 PMCID: PMC5734417 DOI: 10.1136/bmjopen-2016-015374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The occupational risk for Legionella infection among dental healthcare workers (DHCWs) is conjectured because of the risk of routine inhalation of potentially contaminated aerosols produced by the dental instruments. Nevertheless, occupational epidemiology studies are contrasting. This meta-analysis assessed the level of scientific evidence regarding the relative occupational risk for Legionella infection among DHCWs. METHODS Literature search was performed without time and language restrictions, using broad data banks (PubMed, Scopus, Web of Science, GOOGLE Scholar) and generic keywords ('legionella' AND 'dent*'). Analytical cross-sectional studies comparing prevalence of high serum Legionella antibody levels in DHCWs and occupationally unexposed individuals were considered. The relative occupational risk was assessed through prevalence ratio (PR) with 95% CI. Between-study heterogeneity was assessed (Cochran's Q test) and was used to choose the meta-analytic method. Study quality (modified Newcastle-Ottawa Scale) and publication bias (Begg and Mazumdar's test, Egger and colleagues' test, trim and fill R0 method) were assessed formally and considered for the sensitivity analysis. Sensitivity analysis to study inclusion, subgroup analyses (dental staff categories; publication year, before vs after 1998, ie, 5 years after the release by the Centers for Disease Control and Prevention of the infection control guidelines in dental healthcare setting) were performed. RESULTS Seven studies were included (2232 DHCWs, 1172 occupationally unexposed individuals). No evidence of publication bias was detected. The pooled PR estimate was statistically non-significant at 95% level (1.7; 95% CI 0.8 to 3.2), study-quality adjustment did not change the PR considerably (PR, 1.5; 95% CI 0.5 to 4.1). PR was statistically significant before 1998 and no longer significant after 1998. Subgroup analysis according to DHCW categories was inconclusive. CONCLUSIONS There is no scientific evidence that DHCWs are at high occupational risk. The differences between former and recent studies could be due to different characteristics of municipal water systems and the infection control guideline dissemination.
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Affiliation(s)
- Stefano Petti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Petti S. From 'Legionellosis acquired through a dental unit' to 'Was Legionellosis acquired through a dental unit?'. J Hosp Infect 2017; 96:204-205. [PMID: 28457583 DOI: 10.1016/j.jhin.2017.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 04/09/2017] [Indexed: 11/18/2022]
Affiliation(s)
- S Petti
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
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Petti S. Did a patient acquire Legionella pneumophila from the cup filler of a dental unit or did a patient infected with L. pneumophila contaminate the cup filler? J Hosp Infect 2017; 96:201-202. [PMID: 28262432 DOI: 10.1016/j.jhin.2017.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 11/15/2022]
Affiliation(s)
- S Petti
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
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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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Petti S. Healthcare Outbreaks Associated With Dental Unit Water Systems: Strong Scientific Evidence of Minimal Risk. Clin Infect Dis 2016; 63:1270. [PMID: 27501839 DOI: 10.1093/cid/ciw534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stefano Petti
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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