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Souza MA, Steier L, Vanin GN, Zanella ML, Pizzi CM, Ferreira ER, Dallepiane FG, Piccolo NM, da Silva Koch J, Souza KR, Costa UMD, Dos Santos VV, Palatynska-Ulatowska A, de Figueiredo JAP. Antimicrobial action, cytotoxicity and erosive potential of hypochlorous acid obtained from an electrolytic device compared with sodium hypochlorite. Clin Oral Investig 2024; 28:282. [PMID: 38683234 DOI: 10.1007/s00784-024-05675-6] [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: 02/16/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES This study aimed to compare the antimicrobial action, cytotoxicity, cleaning ability, and erosion of dentine of hypochlorous acid (HClO) obtained from an electrolytic device at two different concentrations (Dentaqua) and three concentrations of sodium hypochlorite (NaOCl). METHODS Microbiological test-The root canals of sixty single-rooted extracted human teeth were inoculated with Enterococcus faecalis and divided into 6 groups (n = 10), according to decontamination protocol: DW (control); 1% NaOCl; 2.5% NaOCl; 5.25% NaOCl; 250 ppm HClO and 500 ppm HClO. The colony-forming units were counted to evaluate the decontamination potential of each group, calculating the reduction in bacterial percentage. Cytotoxicity test-Cytotoxicity was evaluated after inoculation of the same tested protocols in fibroblastic cells for 3 min, calculating the cell viability percentages. Specifical statistical analysis was performed (α = 5%). Cleaning ability and erosion-Fifty-six single-rooted bovine lower incisors were divided into seven groups of 8 roots each, being the test groups 1% NaOCl; 2.5% NaOCl; 5,25% NaOCl; 250 ppm HClO and 500 ppm HClO, and a negative and positive control. Negative control was not contaminated, and the other groups were inoculated with Enterococcus faecalis. SEM images were ranked as from the cleanest to the least clean. Erosion was also assessed, being ranked from the least to the most eroded dentine. RESULTS The highest bacterial reduction was observed in experimental groups, with no statistical differences between them (p > 0.05). The highest number of viable cells was observed in control group, followed by 250 ppm HClO and 500 ppm HClO groups, with statistical differences between them (p < 0.05). 1% NaOCl; 2.5% NaOCl; 5.25% NaOCl and 500 ppm HClO displayed the cleanest areas. All sodium hypochlorite groups displayed erosion with higher ranks with greater concentration, while hypochlorous acid did not display any erosion regardless the concentration. CONCLUSIONS It is possible to conclude that HClO obtained from an electrolytic device presented high antimicrobial activity and low cytotoxicity in both tested concentrations. 500 ppm HClO did not display erosion and showed great cleaning ability. CLINICAL RELEVANCE The use of 500 ppm hypochlorous acid may reduce unfavorable behavior of sodium hypochlorite whilst maintaining its antimicrobial action.
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Affiliation(s)
- Matheus Albino Souza
- School of Dentistry, Graduate Program in Dentistry, University of Passo Fundo - UPF. BR 285/São José, Prédio A7, Apto 2, Passo Fundo, RS, CEP: 9052-900, Brazil
| | - Liviu Steier
- School of Dental Medicine, University of Pennsylvania - UPENN, 240 South 40Th Street (40Th & Locust St.), Philadelphia, PA, ZIP19104, USA
| | - Gabriele Nichetti Vanin
- School of Dentistry, Graduate Program in Dentistry, University of Passo Fundo - UPF. BR 285/São José, Prédio A7, Apto 2, Passo Fundo, RS, CEP: 9052-900, Brazil
| | - Mylena Lazareti Zanella
- School of Dentistry, Graduate Program in Dentistry, University of Passo Fundo - UPF. BR 285/São José, Prédio A7, Apto 2, Passo Fundo, RS, CEP: 9052-900, Brazil
| | - Camila Monteiro Pizzi
- School of Dentistry, Graduate Program in Dentistry, University of Passo Fundo - UPF. BR 285/São José, Prédio A7, Apto 2, Passo Fundo, RS, CEP: 9052-900, Brazil
| | - Eduarda Rizzon Ferreira
- School of Dentistry, Graduate Program in Dentistry, University of Passo Fundo - UPF. BR 285/São José, Prédio A7, Apto 2, Passo Fundo, RS, CEP: 9052-900, Brazil
| | - Felipe Gomes Dallepiane
- School of Dentistry, Graduate Program in Dentistry, University of Passo Fundo - UPF. BR 285/São José, Prédio A7, Apto 2, Passo Fundo, RS, CEP: 9052-900, Brazil
| | - Nathan Mateus Piccolo
- School of Dentistry, Graduate Program in Dentistry, University of Passo Fundo - UPF. BR 285/São José, Prédio A7, Apto 2, Passo Fundo, RS, CEP: 9052-900, Brazil
| | - Jordana da Silva Koch
- Graduate Program in Dentistry, Oral Biology Lab, Federal University of Rio Grande do Sul - UFRGS, Rua Sarmento Leite 500 Sala 134, Porto Alegre, RS, CEP90050-170, Brazil
| | - Kellyn Rocca Souza
- Graduate Program in Dentistry, Oral Biology Lab, Federal University of Rio Grande do Sul - UFRGS, Rua Sarmento Leite 500 Sala 134, Porto Alegre, RS, CEP90050-170, Brazil
| | - Ubirajara Maciel da Costa
- School of Veterinary Medicine, State University of Santa Catarina - UDESC, Av. Luiz de Camões, 2090, Conta Dinheiro, Lages, SC, CEP: 88.520-000, Brazil
| | - Vanessa Valgas Dos Santos
- School of Medicine, University of Planalto Catarinense - UNIPLAC, Av. Mal. Castelo Branco 170, Lages, SC, CEP 88526-075, Brazil
| | - Aleksandra Palatynska-Ulatowska
- Department of Endodontics, Medical Faculty, Division of Dentistry, Medical University of Lödz, 251 Pomorska Street, Lödz, 92-213, Poland
| | - José Antônio Poli de Figueiredo
- Graduate Program in Dentistry, Oral Biology Lab, Federal University of Rio Grande do Sul - UFRGS, Rua Sarmento Leite 500 Sala 134, Porto Alegre, RS, CEP90050-170, Brazil.
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Krishnan CS, Tompkins GR, Lyons KM, Cannon RD. Electrolysed oxidising water as a multi-purpose biocide in dental healthcare-A scoping review. Gerodontology 2023; 40:422-462. [PMID: 37694292 DOI: 10.1111/ger.12712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES The objective of this scoping review was to map evidence of electrolysed oxidising water (EOW) as a biocide for dental applications of relevance to older people and identify research gaps. BACKGROUND EOW is an emerging, "green," and cost-effective biocide. There are no reviews on the landscape of EOW research as either an antiseptic or disinfectant in dental healthcare or its suitability for the oral healthcare of older people. MATERIALS AND METHODS The review follows the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Database searches (Google Scholar, PubMed, Web of Science, Ovid, Scopus and Science Direct) were undertaken using MESH terms and Boolean operators with no date restrictions, to identify full-text, original reports published in English-language peer-reviewed journals. RESULTS The search yielded 114 papers that met the inclusion/exclusion criteria. Dental applications of EOW include its use as an endodontic irrigant (39%); mouth rinse/surgical irrigant (21%); disinfectant for dental unit water lines (19%) and dental biomaterials (17%); and for antimicrobial efficacy, effects on oral tissues and on dental material properties. Most studies (83%) evaluated a single EOW formulation (acidic, moderately acidic or neutral) that was either generated at 'point-of-use' (POU; 72%), bottled ('ready-to-use', RTU; 24%) or from unspecified (3%) sources. Six reports evaluated storage-related parameters and 25 evaluated clinical applications; 89 were in vitro studies and one investigated the cost-effectiveness of POU EOW. CONCLUSIONS Neutral-pH, EOW is effective as an antimicrobial agent without deleterious effects on oral tissues. However, research on the impact of storage conditions, anti-Candida biofilm efficacy and mechanism of action against yeasts, long-term effects on denture materials and cost-effectiveness is required to establish the suitability of EOW as a multipurpose biocide for dental healthcare, including infection-control requirements relating to older people.
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Affiliation(s)
- Chitra S Krishnan
- Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Geoffrey R Tompkins
- Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Karl M Lyons
- Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Richard D Cannon
- Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Ozsoy FS, Muftuoglu O, Bulut A, Torun OY, Memikoğlu UT. The Effect of Hydrogen Peroxide Colloidal-Ag Used in Dental Unit Waterline on Shear Bond Strength of Orthodontic Brackets. Niger J Clin Pract 2023; 26:1610-1615. [PMID: 38044762 DOI: 10.4103/njcp.njcp_716_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 07/31/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND The quality of the water passing through the water lines is crucial to dental procedures. Studies on bracket adhesion of hydrogen peroxide colloidal-Ag, which is widely used to prevent biofilm formation, are limited in the literature. AIM To determine whether disinfecting the dental units' waterlines (DUW) with hydrogen peroxide colloidal-Ag has any effect on the shear bond strength (SBS) of orthodontic brackets bonded to enamel. MATERIALS AND METHODS Sixty premolar teeth were divided randomly into two groups. The study and control groups consists of 30 teeth that were etched for 30 seconds with 37% phosphoric acid. Study groups washed with hydrogen peroxide colloidal-Ag water and the control group washed with municipal water. Transbond XT adhesive system was used to bond stainless steel brackets on all the teeth. A 300-g force was applied using a tension gauge to ensure a uniform adhesive thickness and light cured with 6 seconds. The SBS was quantified by means of a universal testing machine. The residual adhesive on the enamel surface was evaluated after debonding using the adhesive remnant index (ARI). RESULTS The t-test results indicated that there were no significant differences in the SBS. The comparison of the results of ARI scores was found statistically insignificant. CONCLUSION It has been found that hydrogen peroxide colloidal-Ag, which is used to reduce the amount of biofilm in DUW, does not have a negative effect on the adhesion of the brackets.
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Affiliation(s)
| | - O Muftuoglu
- Department of Orthodontics, Ankara Medipol University, Ankara, Turkey
| | - A Bulut
- Private Practice, Ankara, Turkey
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Cárdenas AM, Campos-Bijit V, Di Francesco F, Schwarz F, Cafferata EA, Vernal R. Electrolyzed water for the microbiologic control in the pandemic dental setting: a systematic review. BMC Oral Health 2022; 22:579. [PMID: 36494635 PMCID: PMC9733258 DOI: 10.1186/s12903-022-02528-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/21/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Electrolyzed water has brought recent attention due to its antimicrobial properties. Indeed, electrolyzed water has been proposed to sterilize dental materials and instruments without compromising their structural integrity. In addition, electrolyzed water has been proposed as a mouthwash to control bacterial and viral oral infections without detrimental effects on the oral mucosa. However, no current consensus or evidence synthesis could indicate its potentially favorable use in the dental setting, particularly during the COVID-19 context. Therefore, this systematic review aimed to elucidate whether electrolyzed water could improve microbiologic control in the COVID-19 pandemic dental setting. METHODS MEDLINE via Pubmed, EMBASE, Cochrane's CENTRAL, Scopus, LILACS, and Web of Science databases were searched up to September 2021 to identify experimental studies utilizing electrolyzed water for eliminating microorganisms in a dental setting. Besides, a manual and a grey literature search were performed. The data selection and extraction were performed individually and in duplicate. The Risk of Bias (RoB) was assessed with the Nature Publication Quality Improvement Project (NPQIP) score sheet. The study protocol was registered at PROSPERO CRD42020206986. RESULTS From a total of 299 articles, 63 studies met the inclusion criteria. The included studies assessed several types of electrolyzed waters, which showed a high disinfection potential when used to deal with different oral conditions. Electrolyzed water demonstrated a broad antimicrobial spectrum and was highly efficient in the dental office disinfection against viruses, fungi, and bacteria, being compatible with most dental materials. In addition, electrolyzed water could protect against SARS-CoV-2 infection and contamination in the dental office. Regarding the RoB, only 35.18% of entries were answered as 'Yes', thus achieving less than half of the reporting sheet. CONCLUSION Electrolyzed water effectively disinfects contaminated surfaces, dental materials, and equipment. Therefore, their use is recommendable in the SARS-CoV-2 pandemic dental setting.
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Affiliation(s)
- Angélica M. Cárdenas
- grid.443909.30000 0004 0385 4466Periodontal Biology Laboratory, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone Pohlhammer 943, 8380492 Santiago, Independencia Chile ,grid.442190.a0000 0001 1503 9395Faculty of Dentistry, Universidad Santo Tomás, Bucaramanga, Colombia ,Department of Science and Innovation, BIOMEP Research Group, Bucaramanga, Colombia
| | - Vanessa Campos-Bijit
- grid.443909.30000 0004 0385 4466Periodontal Biology Laboratory, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone Pohlhammer 943, 8380492 Santiago, Independencia Chile
| | - Fabrizio Di Francesco
- grid.9841.40000 0001 2200 8888Multidisciplinary Department of Medical, Surgical and Dental Sciences, Campania University Luigi Vanvitelli, Naples, Italy
| | - Frank Schwarz
- grid.7839.50000 0004 1936 9721Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Emilio A. Cafferata
- grid.7839.50000 0004 1936 9721Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany ,grid.430666.10000 0000 9972 9272Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Av. Paseo de la República 5544, 15074 Lima, Miraflores Peru
| | - Rolando Vernal
- grid.443909.30000 0004 0385 4466Periodontal Biology Laboratory, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone Pohlhammer 943, 8380492 Santiago, Independencia Chile
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Nguyen K, Bui D, Hashemi M, Hocking DM, Mendis P, Strugnell RA, Dharmage SC. The Potential Use of Hypochlorous Acid and a Smart Prefabricated Sanitising Chamber to Reduce Occupation-Related COVID-19 Exposure. Risk Manag Healthc Policy 2021; 14:247-252. [PMID: 33519249 PMCID: PMC7837568 DOI: 10.2147/rmhp.s284897] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/03/2020] [Indexed: 02/04/2023] Open
Abstract
This work is part of a project on the development of a smart prefabricated sanitising chamber (SPSC) to provide extra measures against the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Stabilised hypochlorous acid (HOCl) is an approved disinfectant against SARS-CoV-2 by the Environmental Protection Association US in its liquid form on non-porous surfaces. This review is extended to cover its viricidal/bactericidal efficacy in aerosolised or sprayed form which showed an effective dose of as low as 20 ppm and the exposure duration of at least 60 s. The aerosolised application was also recommended with particle size of less than 200 μm to increase the contact with pathogens. The review also includes the safety and toxicity of HOCl with different concentrations. The review calls for more investigations into the effect of HOCl in mist and fog form on the respiratory system when transitioning through the proposed SPSC.
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Affiliation(s)
- Kate Nguyen
- School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - Dinh Bui
- Centre of Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mahak Hashemi
- School of Engineering, RMIT University, Melbourne, Victoria, Australia.,ARC Training Centre on Advanced Manufacturing of Prefabricated Housing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dianna M Hocking
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Priyan Mendis
- ARC Training Centre on Advanced Manufacturing of Prefabricated Housing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard A Strugnell
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Centre of Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
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Kumar PS, Geisinger ML, Avila-Ortiz G. Methods to mitigate infection spread from aerosol-generating dental procedures. J Periodontol 2021; 92:784-792. [PMID: 33382091 DOI: 10.1002/jper.20-0567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/25/2020] [Accepted: 08/30/2020] [Indexed: 12/30/2022]
Abstract
Infection control measures play a critical role in preventing the spread of disease in healthcare settings. Concerns that SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the virus that causes Coronavirus Disease 2019, may be transmitted through droplets and aerosols from both symptomatic and asymptomatic individuals has turned the spotlight on healthcare interventions that involve aerosol generation in the oral cavity, such as many dental and periodontal procedures. This commentary seeks to familiarize the dental practitioner with various infection control methods that may be implemented to mitigate spread of infection in dental settings through aerosol-generating dental procedures.
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Affiliation(s)
- Purnima S Kumar
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
| | - Maria L Geisinger
- Department of Periodontology, University of Alabama at Birmingham School of Dentistry, Birmingham, AL
| | - Gustavo Avila-Ortiz
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA
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Hypochlorous Acid: A Review. J Oral Maxillofac Surg 2020; 78:1461-1466. [PMID: 32653307 PMCID: PMC7315945 DOI: 10.1016/j.joms.2020.06.029] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/07/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
Abstract
The surgeon needs to have an inexpensive, available, nontoxic, and practical disinfectant that is effective in sanitizing against the COVID-19 (Coronavirus Disease 2019) virus. The purpose of this article was to review the evidence for using hypochlorous acid in the office setting on a daily basis. The method used to assemble recommendations was a review of the literature including evidence for this solution when used in different locations and industries other than the oral-maxillofacial clinic facility. The results indicate that this material can be used with a high predictability for disinfecting against the COVID-19 (Coronavirus Disease 2019) virus.
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8
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Proto A, Zarrella I, Cucciniello R, Pironti C, De Caro F, Motta O. Bactericidal and Fungicidal Activity in the Gas Phase of Sodium Dichloroisocyanurate (NaDCC). Curr Microbiol 2016; 73:287-91. [PMID: 27086304 DOI: 10.1007/s00284-016-1040-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/04/2016] [Indexed: 11/28/2022]
Abstract
Sodium dichloroisocyanurate (NaDCC) is usually employed as a disinfectant for the treatment of water, environmental surfaces and medical equipment principally for its effectiveness as a microbicide agent. In this study, we explore the possibility of a new use for NaDCC by investigating the microbicidal activity of chlorine, which derives from the hydrolysis of NaDCC mediated by air humidity, and by testing its effect on the neutralization of microbes present in domestic waste. NaDCC was inserted in a plastic garbage can where LB agar plates, with different dilutions of a known title of four different microorganisms (Escherichia coli, Staphylococcus aureus, Debaryomyces hansenii and Aspergillus brasiliensis), were weakly inserted. The molecular chlorine (Cl2) levels present in the garbage can were quantified using an iodometric titration. The gas emitted in the garbage can presented a strong microbicide effect, inhibiting the proliferation of all four microorganisms and for four consecutive weeks, thus showing that NaDCC hydrolysis, mediated by air humidity, is able to ensure the decontamination of restricted environments, avoiding the proliferation of both Gram-positive and Gram-negative bacteria as well as fungi.
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Affiliation(s)
- Antonio Proto
- Department of Chemistry and Biology, University of Salerno, Via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Ilaria Zarrella
- Department of Medicine and Surgery, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.
| | - Raffaele Cucciniello
- Department of Chemistry and Biology, University of Salerno, Via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Concetta Pironti
- Department of Chemistry and Biology, University of Salerno, Via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Francesco De Caro
- Department of Medicine and Surgery, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Oriana Motta
- Department of Medicine and Surgery, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
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López FU, Kopper PMP, Bona AD, Steier L, Figueiredo JAPD, Vier-Pelisser FV. Effect of Different Irrigating Solutions and Photo-Activated Therapy for In Vivo Root Canal Treatment. Braz Dent J 2015. [DOI: 10.1590/0103-6440201300154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
This study aimed to evaluate histologically the effect of irrigation with 400 ppm Sterilox, 2% and 5% sodium hypochlorite (NaOCl), with and without photo-activated therapy (PAD), in a single-visit root canal treatment of dog's teeth with apical periodontitis (AP). Ten dogs were randomly divided into two groups (n=5): with and without PAD, and the root canals into four subgroups, according to the irrigating solution: SX (400 ppm Sterilox), SH2 (2% NaOCl), SH5 (5% NaOCl) and SS (saline solution) as positive control. A total of 134 root canals were opened and left exposed to the oral environment for 14 days and then sealed for 60 days for AP induction. Then, root canals were treated according to each proposed disinfecting protocol and filled in the same session. After 120 days, the dogs were euthanized and the periapical inflammatory events were evaluated under light microscopy. Qualitative data were submitted to Kruskal-Wallis and Mann-Whitney tests (α=0.05). PAD did not produce significant differences in the scores for apical inflammation when used after chemo-mechanical preparation (p>0.05). The irrigating solutions SX, SH2 and SH5 without PAD were statistically different from SS (p<0.05) that presented the greatest scores for apical inflammation. PAD did not show any additional effect for the treatment of root canals with pulp necrosis and AP in a single visit and 400 ppm Sterilox may be considered an alternative to NaOCl in root canal treatment.
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Gunaydin M, Esen S, Karadag A, Unal N, Yanik K, Odabasi H, Birinci A. In vitro antimicrobial activity of Medilox® super-oxidized water. Ann Clin Microbiol Antimicrob 2014; 13:29. [PMID: 25023905 PMCID: PMC4107540 DOI: 10.1186/1476-0711-13-29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/28/2014] [Indexed: 11/30/2022] Open
Abstract
Aim Super-oxidized water is one of the broad spectrum disinfectants, which was introduced recently. There are many researches to find reliable chemicals which are effective, inexpensive, easy to obtain and use, and effective for disinfection of microorganisms leading hospital infections. Antimicrobial activity of super-oxidized water is promising. The aim of this study was to investigate the in-vitro antimicrobial activity of different concentrations of Medilox® super-oxidized water that is approved by the Food and Drug Administration (FDA) as high level disinfectant. Material and methods In this study, super-oxidized water obtained from Medilox® [Soosan E & C, Korea] device, which had been already installed in our hospital, was used. Antimicrobial activities of different concentrations of super-oxidized water (1/1, 1/2, 1/5, 1/10, 1/20, 1/50, 1/100) at different exposure times (1, 2, 5, 10, 30 min) against six ATCC strains, eight antibiotic resistant bacteria, yeasts and molds were evaluated using qualitative suspension test. Dey-Engley Neutralizing Broth [Sigma-Aldrich, USA] was used as neutralizing agent. Results Medilox® was found to be effective against all standard strains (Acinetobacter baumannii 19606, Escherichia coli 25922, Enterococcus faecalis 29212, Klebsiella pneumoniae 254988, Pseudomonas aeruginosa 27853, Staphylococcus aureus 29213), all clinical isolates (Acinetobacter baumannii, Escherichia coli, vancomycin-resistant Enterococcus faecium, Klebsiella pneumoniae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, Bacillus subtilis, Myroides spp.), and all yeastsat 1/1 dilution in ≥ 1 minute. It was found to be effective on Aspergillus flavus at 1/1 dilution in ≥ 2 minutes and on certain molds in ≥ 5 minutes. Conclusion Medilox® super-oxidized water is a broad spectrum, on-site producible disinfectant, which is effective on bacteria and fungi and can be used for the control of nosocomial infection.
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Affiliation(s)
- Murat Gunaydin
- Department of Medical Microbiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.
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11
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Vatansever F, de Melo WCMA, Avci P, Vecchio D, Sadasivam M, Gupta A, Chandran R, Karimi M, Parizotto NA, Yin R, Tegos GP, Hamblin MR. Antimicrobial strategies centered around reactive oxygen species--bactericidal antibiotics, photodynamic therapy, and beyond. FEMS Microbiol Rev 2013; 37:955-89. [PMID: 23802986 DOI: 10.1111/1574-6976.12026] [Citation(s) in RCA: 578] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 12/13/2022] Open
Abstract
Reactive oxygen species (ROS) can attack a diverse range of targets to exert antimicrobial activity, which accounts for their versatility in mediating host defense against a broad range of pathogens. Most ROS are formed by the partial reduction in molecular oxygen. Four major ROS are recognized comprising superoxide (O2•-), hydrogen peroxide (H2O2), hydroxyl radical (•OH), and singlet oxygen ((1)O2), but they display very different kinetics and levels of activity. The effects of O2•- and H2O2 are less acute than those of •OH and (1)O2, because the former are much less reactive and can be detoxified by endogenous antioxidants (both enzymatic and nonenzymatic) that are induced by oxidative stress. In contrast, no enzyme can detoxify •OH or (1)O2, making them extremely toxic and acutely lethal. The present review will highlight the various methods of ROS formation and their mechanism of action. Antioxidant defenses against ROS in microbial cells and the use of ROS by antimicrobial host defense systems are covered. Antimicrobial approaches primarily utilizing ROS comprise both bactericidal antibiotics and nonpharmacological methods such as photodynamic therapy, titanium dioxide photocatalysis, cold plasma, and medicinal honey. A brief final section covers reactive nitrogen species and related therapeutics, such as acidified nitrite and nitric oxide-releasing nanoparticles.
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Affiliation(s)
- Fatma Vatansever
- The Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA; Department of Dermatology, Harvard Medical School, Boston, MA, USA
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12
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Rossi-Fedele G, Doğramacı EJ, Steier L, de Figueiredo JAP. Interaction between chlorhexidine-impregnated gutta-percha points and several chlorine-containing endodontic irrigating solutions. Int Endod J 2013; 46:675-80. [PMID: 23331158 DOI: 10.1111/iej.12044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 12/06/2012] [Indexed: 11/29/2022]
Abstract
AIM To evaluate if the immersion of chlorhexidine-impregnated gutta-percha points in chlorine-containing endodontic irrigants causes colour changes and precipitate formation. METHODOLOGY Eighty-one size 25 chlorhexidine medicated (Activ Points, Roeko, Langenau, Germany) and 27 size 25 standard gutta-percha points (Roeko) were immersed in microtubes, containing the following solutions: 0.5 and 5.25% NaOCl or Aquatine (Optident, Ilkley, UK). The samples were visually assessed, by two independent observers, at regular intervals over 3 weeks, to detect colour changes and precipitate formation. A score system was used to grade the precipitate intensity. To compare the number of days required for a precipitate to form mean and standard differences were calculated; the means between the groups were compared using a one-way analysis of variance test. Mean intensity scores were calculated and compared between groups using Kruskal-Wallis procedure followed by the Mann-Whitney test. RESULTS The groups containing 5.25% NaOCl started to produce a visible precipitate after fourteen days (16.48 ± 0.98) for the Activ points; this process was first noticed with the standard gutta-percha group on day 17 (18.33 ± 1.22 days), with a statistically significant difference (P = 0.002). When looking at the intensity scores from day 17 onwards, these two groups differed statistically, with a greater amount for the AP group (P < 0.001). No other test group presented with changes. CONCLUSION The placement of impregnated gutta-percha points, in 5.25% NaOCl for a 2-week period, caused the formation of a precipitate in the experimental conditions of this study.
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Affiliation(s)
- G Rossi-Fedele
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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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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Rossi-Fedele G, Guastalli AR, Doğramacı EJ, Steier L, De Figueiredo JAP. Influence of pH changes on chlorine-containing endodontic irrigating solutions. Int Endod J 2011; 44:792-9. [DOI: 10.1111/j.1365-2591.2011.01911.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Rossi-Fedele G, Figueiredo JAPD, Steier L, Canullo L, Steier G, Roberts AP. Evaluation of the antimicrobial effect of super-oxidized water (Sterilox®) and sodium hypochlorite against Enterococcus faecalis in a bovine root canal model. J Appl Oral Sci 2011; 18:498-502. [PMID: 21085808 PMCID: PMC4246382 DOI: 10.1590/s1678-77572010000500012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 09/28/2009] [Indexed: 12/03/2022] Open
Abstract
Ideally root canal irrigants should have, amongst other properties, antimicrobial
action associated with a lack of toxicity against periapical tissues. Sodium
hypochlorite (NaOCl) is a widely used root canal irrigant, however it has been shown
to have a cytotoxic effect on vital tissue and therefore it is prudent to investigate
alternative irrigants. Sterilox's Aquatine Alpha Electrolyte®
belongs to the group of the super-oxidized waters; it consists of a mixture of
oxidizing substances, and has been suggested to be used as root canal irrigant.
Super-oxidized waters have been shown to provide efficient cleaning of root canal
walls, and have been proposed to be used for the disinfection of medical
equipment.
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Some factors influencing the stability of Sterilox(®), a super-oxidised water. Br Dent J 2011; 210:E23. [PMID: 21372834 DOI: 10.1038/sj.bdj.2011.143] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2010] [Indexed: 11/09/2022]
Abstract
Super-oxidised waters, particularly Sterilox(®), have been suggested for the disinfection of dental unit water lines and dental impression materials owing to their antimicrobial efficacy. One of the previously suggested characteristics is their short shelf life. The purpose of this investigation was to understand the effect of storage conditions on Sterilox(®)'s stability. Eight bottles (four completely full, four half-full) of freshly prepared solution were divided into four groups and subsequently stored by being either exposed to or protected from sunlight. The chlorine concentration was monitored using chlorine test strips until the concentration reached zero, or until the thirteenth week. Statistically significant differences between the groups exposed to sunlight and the non-exposed groups (p <0.001) were found. The mean loss of chlorine per day for the non-exposed samples was 1.01 mg/L, whilst the mean for the exposed samples was 2.42 mg/L. The presence of air did not affect the chlorine decomposition in the bottles. The results of this investigation indicate that when the solution is exposed to sunlight, the decrease of chlorine starts at day 4, whilst for the groups sheltered from sunlight, the process started after day 14. Therefore, Sterilox(®) solutions appear to be more stable than previously surmised.
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Garcia F, Murray PE, Garcia-Godoy F, Namerow KN. Effect of Aquatine Endodontic Cleanser on smear layer removal in the root canals of ex vivo human teeth. J Appl Oral Sci 2010; 18:403-8. [PMID: 20835577 PMCID: PMC5349080 DOI: 10.1590/s1678-77572010000400014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 03/14/2010] [Indexed: 11/22/2022] Open
Abstract
Objectives The purpose of this study was to measure and compare the root canal cleanliness
and smear layer removal effectiveness of Aquatine Endodontic Cleanser (Aquatine
EC) when used as an endodontic irrigating solution in comparison with 6% sodium
hypochlorite (NaOCl). Material and Methods Forty-five human teeth were randomly allocated to five treatment groups; the pulp
chamber was accessed, cleaned, and shaped by using ProTaper and ProFile rotary
instrumentation to an ISO size #40. The teeth were then processed for scanning
electron microscopy, and the root canal cleanliness and removal of smear layer
were examined. Results The most effective removal of smear layer occurred with Aquatine EC and NaOCl,
both with a rinse of EDTA. Conclusions Aquatine EC appears to be the first hypochlorous acid approved by the FDA to be a
possible alternative to the use of NaOCl as an intracanal irrigant. Further
research is needed to identify safer and more effective alternatives to the use of
NaOCl irrigation in endodontics.
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Affiliation(s)
- Faustino Garcia
- Department of Endodontics, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, Florida 33328-2018, USA
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Chate RAC. An audit improves the quality of water within the dental unit water lines of general dental practices across the East of England. Br Dent J 2010; 209:E11. [PMID: 20885414 DOI: 10.1038/sj.bdj.2010.885] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2010] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate and improve upon the quality of water emanating from the dental unit waterlines (DUWLs) which supply irrigation for dental handpieces and triple spray syringes in general practice. DESIGN A prospective clinical audit. SETTING Seventy-two general dental practices in the East of England. METHODS In 2006, 124 dentists initially registered to participate in the audit. By 2007, 72 had begun and by 2008, 68 had completed the project. This involved collecting samples of water discharged from the DUWLs in the dental practices both before the start and mid-way through a morning session. These were tested microbiologically at a United Kingdom Accreditation Service testing laboratory. INTERVENTIONS Before the audit, 56% of the DUWLs were reportedly flushed through for 2 minutes at the start of the day, 29% were purged for 20 seconds in between each patient, 50% were treated with a wide range of different disinfectant solutions, 44% were drained down dry at the end of the day and 9% had no cross-infection control measures applied to them at all. In the audit, 100% used a disinfectant solution alone, predominantly either Alpron or Sterilox. MAIN OUTCOME MEASURES The minimum audit standard set was for the water samples to meet the United States' Centers for Disease Control and Prevention (CDC) guideline on the quality of DUWL water, namely that the United States' Environmental Protection Agency (EPA) regulatory standards for drinking water be adopted, in that no more than 5% of water samples should be contaminated with total coliforms and that they should not have more than 500 colony forming units per ml (cfu/ml) of heterotrophic water bacteria. However, the participating dentists were encouraged to try and achieve the more stringent European Union (EU) standards for potable (drinking) water, namely for the water samples to have neither Escherichia coli nor any other faecal coliforms present and for the aerobic colony count to be less than 100 cfu/ml at 22°C after 72 hours of culturing. RESULTS In the pre-audit survey, none of the 72 DUWL water samples were contaminated with E. coli but in five of them (7%) coliforms were recovered. Only 25% reached the EU potable water standard, of which 11% had zero planktonic bacterial contamination. Three percent were above the EU standard but below the CDC guideline/EPA regulatory drinking water standard, while alarmingly, 72% of them failed to reach this minimum audit standard altogether. However, after the application of a suitable disinfectant for at least a month, the audit revealed that E. coli still remained absent in the water samples taken from the 68 DUWLs that completed the project and in only one (1.5%) were coliforms recovered. Remarkably, nearly 81% reached the EU potable water standard, of which 54% had zero planktonic bacterial contamination, with nearly an additional 6% reaching the American CDC/EPA standard and with only 13% failing outright. CONCLUSIONS Clinical audit using appropriate DUWL disinfectants can result in the improvement of the quality of water that is discharged through DUWLs, thereby minimising both the risk of cross-infection to vulnerable patients as well as to dental staff chronically exposed to contaminated aerosols.
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Affiliation(s)
- R A C Chate
- Orthodontic Department, Essex County Hospital, Lexden Road, Colchester, UK
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Hope CK, Garton SG, Wang Q, Burnside G, Farrelly PJ. A direct comparison between extracted tooth and filter-membrane biofilm models of endodontic irrigation using Enterococcus faecalis. Arch Microbiol 2010; 192:775-81. [PMID: 20652229 DOI: 10.1007/s00203-010-0604-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 06/21/2010] [Accepted: 07/03/2010] [Indexed: 11/26/2022]
Abstract
Endodontic restorations often fail due to inadequate disinfection of the root canal even though the antimicrobial irrigants used have been shown to be capable of killing the bacterium frequently implicated in this complication, Enterococcus faecalis (Ef). Extracted human teeth were root-prepared and filled with a liquid culture of Ef. Following incubation, the root canals were irrigated with 1% sodium hypochlorite (NaOCl), electrochemically activated water or saline control. Irrigation was modelled using an electronic pipette to deliver the solutions at a reproducible flow velocity. A series of parallel experiments employed a membrane biofilm model that was directly immersed into irrigant. Experimental conditions where contiguous between the extracted tooth model and biofilm model wherever possible. After 60 s of exposure, 1% NaOCl effectively sterilised the biofilm model, whereas log 3.36 viable Ef where recoverable from the analogous extracted tooth model, the other irrigants proved ineffective. Biofilms of Ef were susceptible to concentrations of irrigant that proved ineffective in the tooth model. NaOCl was the most effective biocide in either case. This suggests that the biofilm modality of bacterial growth may not be the most important factor for the recalcitrance of root canal infections during endodontic irrigation; it is more likely due to the inability of the irrigant to access the infection.
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Affiliation(s)
- Christopher K Hope
- School of Dental Sciences, University of Liverpool, Liverpool L69 3GN, UK.
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O’Donnell M, Boyle M, Swan J, Russell R, Coleman D. A centralised, automated dental hospital water quality and biofilm management system using neutral Ecasol™ maintains dental unit waterline output at better than potable quality: A 2-year longitudinal study. J Dent 2009; 37:748-62. [DOI: 10.1016/j.jdent.2009.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 06/02/2009] [Accepted: 06/03/2009] [Indexed: 10/20/2022] Open
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Coleman DC, O'Donnell MJ, Shore AC, Russell RJ. Biofilm problems in dental unit water systems and its practical control. J Appl Microbiol 2009; 106:1424-37. [PMID: 19187140 DOI: 10.1111/j.1365-2672.2008.04100.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- D C Coleman
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental School & Hospital, University of Dublin, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland.
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Martin MV. Decontamination in primary care practice - a curate's egg, good in most parts. Br Dent J 2008; 205:579. [DOI: 10.1038/sj.bdj.2008.1037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Coleman DC, O'Donnell MJ, Shore AC, Swan J, Russell RJ. The role of manufacturers in reducing biofilms in dental chair waterlines. J Dent 2007; 35:701-11. [PMID: 17576035 DOI: 10.1016/j.jdent.2007.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 05/03/2007] [Accepted: 05/08/2007] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES This paper reviews how dental chair unit (DCU) manufacturers can contribute practically to resolving the problem of biofilm formation in dental unit waterlines (DUWs). STUDY SELECTION The review concentrates on how novel developments and changes in a range of specific areas have, and might contribute to DUW biofilm control. These include (i) DCU engineering and design changes; (ii) improvements to DCU supply water quality; (iii) development of automated DUW treatment procedures that are effective at controlling biofilm in the long-term, safe for patients and dental staff, environmentally friendly and which do not exhibit adverse effects on DCU components after prolonged use. SOURCES The majority of the material contained in this review is based on, or supported by the peer-reviewed literature. DATA The current consensus from the literature reveals that the emphasis on DUW biofilm and its control has focused on describing the problem and its control using a range of periodic and residual DUW treatment agents. Unfortunately, until recently, DCU manufacturers have provided very little specific guidance in this regard. Indeed, ensuring that DCUs provide good quality output water has generally been regarded to be the responsibility of dental practitioners. Some recent studies have shown that novel DCUs with integral semi-automated or automated DUW cleaning systems can effectively control DUW biofilm in the long-term. However, there are other potential DCU engineering and design changes that DCU manufacturers could undertake to further improve DUW biofilm control. CONCLUSIONS DCU manufacturers can significantly contribute to controlling the problem of DUW biofilm.
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Affiliation(s)
- D C Coleman
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental School & Hospital, University of Dublin, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland.
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Walker JT, Marsh PD. Microbial biofilm formation in DUWS and their control using disinfectants. J Dent 2007; 35:721-30. [PMID: 17714847 DOI: 10.1016/j.jdent.2007.07.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 07/03/2007] [Accepted: 07/03/2007] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Due to the presence of extended narrow bore tubing and long periods of stagnation, dental unit water systems (DUWs) can be prone to relatively high levels of microbial contamination, including the formation of biofilm and the presence of opportunistic pathogens, irrespective of the source and quality of the inflowing water. Whilst the European Union (EU) has yet to set a definitive microbiological guideline, the American Dental Association (ADA) has set a maximum of <200 colony forming units (cfu)/ml for DUWs water in the USA. The objective of this review is to discuss why microbial contamination and biofilms are so prevalent in DUWs, as well as the role of disinfectants and their potential for achieving microbial water quality levels recommended by the ADA. STUDY SELECTION The review outlines the principal factors responsible for biofilm formation in DUWs and a number of mechanisms used for microbial control. SOURCES The source material contained in this review is taken from the peer-reviewed literature. DATA A variety of disinfectants are available for use, but controlled laboratory and clinical studies have shown that they can vary markedly in their efficacy and suitability for use. Some products have been shown to successfully remove biofilm and consistently reduce the microbial load of out-flowing water to <200 cfu/ml. CONCLUSIONS The effective delivery of approved disinfectants can control the level of microorganisms in DUWs at acceptable levels.
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Affiliation(s)
- J T Walker
- Centre for Emergency Preparedness and Response, HPA Porton Down, Salisbury, United Kingdom
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O'Donnell MJ, Shore AC, Russell RJ, Coleman DC. Optimisation of the long-term efficacy of dental chair waterline disinfection by the identification and rectification of factors associated with waterline disinfection failure. J Dent 2007; 35:438-51. [PMID: 17303302 DOI: 10.1016/j.jdent.2007.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 12/22/2006] [Accepted: 01/03/2007] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED Although many studies have highlighted the problem of biofilm growth in dental chair unit waterlines (DUWs), no long-term studies on the efficacy of DUW disinfection using a large number of dental chair units (DCUs) have been reported. OBJECTIVES To investigate the long-term (21 months) efficacy of the Planmeca Waterline Cleaning System (WCS) to maintain the quality of DUW output water below the American Dental Association (ADA) recommended standard of < or =200cfu/mL of aerobic heterotrophic bacteria using once weekly disinfection with the hydrogen peroxide-and silver ion-containing disinfectant Planosil. METHODS Microbiological quality of DUW output water was monitored by culture on R2A agar for 10 DCUs fitted with the WCS. The presence of biofilm in DUWs was examined by electron microscopy. RESULTS During the first 9 months a high prevalence (28/300 disinfection cycles; 9.3%) of intermittent DUW disinfection failure occurred in 8/10 DCUs due to operator omission to disinfect all DUWs (10/28 failed cycles), incorrect compressed air pressure failing to distribute the disinfectant properly (4/28 failed cycles) and physical blockage of disinfectant intake valves due to corrosion effects of Planosil (14/28 failed cycles). On rectification of these faults through engineering redesign and procedural changes, no further cases of intermittent DUW disinfection failure were observed. Independently of these factors, a rapid and consistent decline in efficacy of DUW disinfection occurred in 4/10 DCUs following the initial 9 months of once weekly disinfection. There was a highly significant difference (P<0.0001) in the prevalence of strongly catalase-positive Novosphingobium and Sphingomonas bacterial species (mean average prevalence of 37.1%) in DUW output water from these 4 DCUs compared to the other 6 DCUs and DCU supply water (prevalence <1%), which correlated with biofilm presence in the DUWs and indicated selective pressure for maintenance of these species by prolonged disinfectant usage. Planosil was reformulated to a more concentrated form (Planosil Forte) and when used once weekly was found to maintain bacterial density in output water below the ADA standard for all 10 DCUs. CONCLUSIONS A variety of factors can contribute to failure of DUW disinfection in the long-term, including human error, disinfectant corrosion of equipment and natural selection of naturally disinfectant-tolerant bacterial species.
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Affiliation(s)
- M J O'Donnell
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental School & Hospital, University of Dublin, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland
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Chate RAC. An audit improves the quality of water within the dental unit water lines of three separate facilities of a United Kingdom NHS Trust. Br Dent J 2007; 201:565-9. [PMID: 17099661 DOI: 10.1038/sj.bdj.4814206] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2006] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To improve the quality of water emanating from dental unit waterlines (DUWLs). DESIGN A prospective clinical audit. SETTING Three geographically separate district dental facilities of a United Kingdom NHS Trust, involving two community clinics and one hospital orthodontic department, which were evaluated between 2002 and 2004. METHODS Samples of water discharged from the DUWLs were collected prior to the start and midway through a morning session. These were tested microbiologically at a United Kingdom Accreditation Service testing laboratory within six hours of sampling. INTERVENTIONS One of the clinics followed the contemporaneous BDA advice of flushing water through its DUWLs while the other two clinics used separate intermittent disinfection purging regimes instead. One of them used a two stage protocol of Ethylene Diamine Tetra-Acetic acid followed by hydrogen peroxide, while the other used Bio 2000 as a single agent, which was subsequently superseded by the continuous use of super-oxidised water (Sterilox). MAIN OUTCOME MEASURE To assess whether the samples either met the American Dental Association's guideline on the quality of DUWL water, or the more stringent European Union standards for potable (drinking) water. RESULTS The two units which used a disinfection regime both complied with the ADA guideline and the EU potable water standard. However, the unit which only flushed through its DUWLs without using a disinfectant failed to comply with either of them. After all three dental facilities subsequently standardised their DUWL disinfection regimes by using Bio 2000, the colony counts from all of the water samples thereafter remained well below the EU recommended level. The unit which progressed to using Sterilox as a continuous disinfectant achieved and maintained zero readings from its water samples. CONCLUSIONS Clinical audit can result in the improvement of the quality of water that is discharged through DUWLs, thereby minimising both the risk of cross infection to vulnerable patients, as well as to dental staff chronically exposed to contaminated aerosols.
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Affiliation(s)
- R A C Chate
- Orthodontic Department, Essex County Hospital, Lexden Road, Colchester, CO3 3NB.
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O'Donnell MJ, Shore AC, Coleman DC. A novel automated waterline cleaning system that facilitates effective and consistent control of microbial biofilm contamination of dental chair unit waterlines: A one-year study. J Dent 2006; 34:648-61. [PMID: 16442201 DOI: 10.1016/j.jdent.2005.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Revised: 12/02/2005] [Accepted: 12/09/2005] [Indexed: 10/25/2022] Open
Abstract
Microbial contamination of dental chair unit (DCU) output water caused by biofilm growth in dental unit waterlines (DUWs) is a universal problem and a potentially significant source of cross-infection. The microbial quality of output water from a Planmeca Compact i DCU equipped with the novel Water Management System (WMS), an integrated and automated DUW cleaning system, was investigated over a 12-month period with the hydrogen peroxide- and silver ion-containing disinfectants Planosil and Planosil Forte. Four weeks after connection to the potable-water quality mains supply the density of aerobic heterotrophic bacteria, rose from the low levels consistently found in the supply water throughout this study (mean average 77 cfu/mL) to 15,400 cfu/mL. Disinfection of DUWs once weekly with Planosil for 10 weeks resulted in a dramatic reduction in bacterial density immediately following disinfection (mean average 26 cfu/mL). Bacterial density rose steadily between disinfections and by 7 days post-disinfection, water quality failed (mean average 384 cfu/mL) the American Dental Association DCU water quality standard of <or=200 cfu/mL. The DCU was then disinfected once weekly for 40 weeks with Planosil Forte. The average bacterial density immediately post-disinfection was 20 cfu/mL and 7 days post-disinfection was 113 cfu/mL. Electron microscopy showed that improved output water quality following disinfection with both disinfectants was associated with marked elimination of DUW biofilm, but deterioration of water quality following disinfection was associated with its regrowth. The most common bacterial species cultured from the mains water and the DCU output water were Microcococcus luteus and Sphingomonas spp., respectively, the latter of which are known opportunistic pathogens. The findings of this study show that the Planmeca Compact i DCU equipped with the easy to use and automated WMS, that requires minimal effort on the part of the operator, consistently provides output water that passes the ADA quality standard of <or=200 cfu/mL for up to 7 days following once-weekly disinfection with Planosil Forte.
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Affiliation(s)
- M J O'Donnell
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental School & Hospital, University of Dublin, Trinity College, Lincoln Place, Dublin 2, Republic of Ireland
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Efficacy of super-oxidised water for disinfection. Br Dent J 2005. [DOI: 10.1038/sj.bdj.4812181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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