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Patil R, Hindlekar A, Jadhav GR, Mittal P, Humnabad V, Di Blasio M, Cicciù M, Minervini G. Comparative evaluation of effect of sodium hypochlorite and chlorhexidine in dental unit waterline on aerosolized bacteria generated during dental treatment. BMC Oral Health 2023; 23:865. [PMID: 37964280 PMCID: PMC10647182 DOI: 10.1186/s12903-023-03585-9] [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: 08/11/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND In dentistry, nosocomial infection poses a great challenge to clinicians. The microbial contamination of water in dental unit waterlines (DUWLs) is ubiquitous. Such infected DUWLs can transmit oral microbes in the form of aerosols. Previous studies have suggested treating DUWLs with various disinfectants to reduce cross-contamination. The literature lacks a comparative evaluation of the effect of the use of 0.2% chlorhexidine (CHX) and 0.1% sodium hypochlorite (NaOCl) in DUWLs on aerosolized bacteria generated during dental procedures. OBJECTIVE To compare the effect of NaOCl and CHX in DUWLs on aerosolized bacteria generated during restorative and endodontic procedures. MATERIALS AND METHODS A total of 132 patients were equally divided into three groups (n = 44 in each group) according to the content of DUWL as follows. Group I-0.1% NaOCl Group II-0.2% CHX Group III-distilled water (Positive control) One-way ANOVA was performed and the Kruskal-Wallis test was used for intergroup comparison. RESULTS For the restorative procedure, inter-group comparison of mean colony-forming units (CFU) scores showed a statistically significant difference between the groups (p - .001) with the score of group 3 higher than group 2 followed by group 1. For the endodontics, an inter-group comparison of CFU scores showed a statistically significant difference between the groups (p - .003) with the mean score in group 1 being the lowest and group 3 being the highest. CONCLUSION The addition of NaOCl or CHX in DUWLs shows an effective reduction in aerosolized bacteria compared to distilled water.
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Affiliation(s)
- Rutuja Patil
- Department of Conservative Dentistry and Endodontics, Dr D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune -18, India
| | - Ajit Hindlekar
- Department of Conservative Dentistry and Endodontics, Dr D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune -18, India
| | | | - Priya Mittal
- Department of Conservative Dentistry and Endodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College & Hospital, Nagpur, India
| | - Vamshi Humnabad
- Department of Conservative Dentistry and Endodontics, Dr D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune -18, India
| | - Marco Di Blasio
- Department of Medicine and Surgery, University Center of Dentistry, University of Parma, 43126, Parma, Italy.
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123, Catania, Italy
| | - Giuseppe Minervini
- Saveetha Dental College & Hospitals, Saveetha Institute of Medical & Technical Sciences Saveetha University, Chennai, India.
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy.
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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: 0] [Impact Index Per Article: 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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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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Sardi JDCO, Gullo FP, Freires IA, Pitangui NDS, Segalla MP, Fusco-Almeida AM, Rosalen PL, Regasini LO, Mendes-Giannini MJS. Synthesis, antifungal activity of caffeic acid derivative esters, and their synergism with fluconazole and nystatin against Candida spp. Diagn Microbiol Infect Dis 2016; 86:387-391. [DOI: 10.1016/j.diagmicrobio.2016.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/11/2016] [Accepted: 08/05/2016] [Indexed: 12/16/2022]
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Pawar A, Garg S, Mehta S, Dang R. Breaking the Chain of Infection: Dental Unit Water Quality Control. J Clin Diagn Res 2016; 10:ZC80-4. [PMID: 27630960 DOI: 10.7860/jcdr/2016/19070.8196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/26/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The air-water syringes, ultrasonic scalers, high speed air turbine handpieces are connected to dental units by a network of small-bore plastic tubes through which water and air travel to activate or cool the instruments and it had been shown that this system is extensively contaminated with microbial biofilms and pose a potential risk of infection for patients as well as dental professionals. AIM To evaluate and compare the efficacy of various disinfectants in reducing the microbial colony count in water derived from Dental Unit Waterlines. MATERIALS AND METHODS Five random dental units were selected and samples were collected before and after intervention with 5 disinfectants (0.02% H2O2 continuously, 0.02% H2O2 continuously with shock treatment with 0.25% H2O2 weekly, 0.12% Chlorohexidine and 12% Ethanol overnight, 1:50 Original Listerine overnight, 2% Sodium Perborate and 2% EDTA 5 minutes in morning) using different disinfection methods for 4 weeks. Samples were cultured on Reasoner's 2A (R2A) agar for microbial counting. RESULTS Results were recorded as Colony forming units/ml (cfu/ml) and were evaluated statistically. Results showed that all the dental unit waterlines were heavily contaminated with microbes before any intervention. After 1 day of disinfection regime the counts reduced significantly and showed progressive reduction in consecutive weeks. Goals set by ADA & CDC were ultimately achieved at the end of 4 weeks. CONCLUSION All the disinfectants were equally effective in reducing the microbial colony count of DUWLs, irrespective of their concentration and method of disinfection.
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Affiliation(s)
- Amrita Pawar
- Senior Lecturer, Department of Prosthodontics, ITS College of Dental Sciences & Research , Muradnagar, Ghaziabad, UP, India
| | - Sandeep Garg
- Professor and Head, Department of Prosthodontics, MM College of Dental Sciences & Research , Mullana, Ambala, Haryana, India
| | - Sonia Mehta
- Associate Professor, Department of Microbiology, MM College of Medical Sciences & Research , Mullana, Ambala, Haryana, India
| | - Rajat Dang
- Professor, Department of Prosthodontics, MM College of Dental Sciences & Research , Mullana, Ambala, Haryana, India
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Komachiya M, Yamaguchi A, Hirai K, Kikuchi Y, Mizoue S, Takeda N, Ito M, Kato T, Ishihara K, Yamashita S, Akihiro K. Antiseptic effect of slightly acidic electrolyzed water on dental unit water systems. THE BULLETIN OF TOKYO DENTAL COLLEGE 2014; 55:77-86. [PMID: 24965952 DOI: 10.2209/tdcpublication.55.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Biofilm formation in dental unit water systems (DUWSs) can contaminate water from three-in-one syringes, air rotors, and low-speed handpieces. This may serve as a potential source of infection for dentists, dental staff, and patients, so these systems must be sterilized. Because slightly acidic electrolyzed water (SAEW) is often used as a disinfectant for food, the aim of this study was to investigate the possibility of using SAEW as a DUWS disinfectant. Slightly acidic electrolyzed water was injected into a dental unit and its effects evaluated. Chemical properties such as chlorine ion and potential hydrogen in the SAEW were measured. Detection of both ordinary and heterotrophic bacteria from the DUWS was performed by culture, and biofilm formation of the bacteria in the DUWS evaluated. Polymerase chain reaction (PCR) was used to detected contamination by nosocomial pathogens. Almost all the chlorine ions in the SAEW were exhausted during the two-day trials, and the pH value of the SAEW fell from 5 to 4. No viable cells were detected in the SAEW collected. Biofilm formation in the water from the DUWS with SAEW was almost at a baseline level, whereas that without SAEW was 4 times higher. The PCR analysis showed that no nosocomial infecting pathogens were detected in the SAEW. The present study demonstrated the antiseptic effect of SAEW in DUWS.
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Affiliation(s)
- Miho Komachiya
- Department of Removable Prosthodontics, School of Dentistry, Matsumoto Dental University
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Sreenivasan PK, Gittins E. The effects of a chlorhexidine mouthrinse on culturable microorganisms of the tongue and saliva. Microbiol Res 2005; 159:365-70. [PMID: 15646383 DOI: 10.1016/j.micres.2004.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A randomized and cross-over design clinical study with normal adult volunteers examined the effects of a 0.12% chlorhexidine (CHX) mouthrinse and a control rinse on a range of microflora including those implicated in halitosis on the tongue and saliva. Saliva and tongue scrapings were collected from 13 subjects prior to treatments with additional samples collected at 3 h post-treatment cultured on media to enumerate anaerobic, Gram-positive and Gram-negative bacteria, odorigenic bacteria producing hydrogen sulphide (H2S) and oral bacteria with proteolytic activity. In comparison to the control, rinsing with CHX demonstrated statistically significant reductions that ranged from 81-90% for tongue microflora with a 89-95% decrease noted on salivary flora (p<0.05). The effects of CHX on anaerobic, Gram-positive and Gram-negative bacteria are in accord with those noted on odorigenic bacteria producing H2S or proteolytic activity. These results help to explain previous clinical results on the malodor efficacy of CHX and highlight microbiological approaches for bacteria implicated in malodor.
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Sreenivasan PK, Gittins E. Effects of low dose chlorhexidine mouthrinses on oral bacteria and salivary microflora including those producing hydrogen sulfide. ACTA ACUST UNITED AC 2004; 19:309-13. [PMID: 15327643 DOI: 10.1111/j.1399-302x.2004.00160.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS Clinical studies have demonstrated the considerable effects of chlorhexidine on dental plaque and oral microbiota as well as improvements in indices of oral health. This investigation examined the efficacy of lower concentrations of chlorhexidine. METHODS Mouthrinses with 0.03%, 0.06%, 0.12% chlorhexidine and a control rinse without chlorhexidine were examined. Alamar blue, an oxidation-reduction dye with fluorescent end-points proportional to bacterial viability, was used to determine bacterial viability. Further clinical studies examined the effects of these rinses on salivary bacteria and on bacteria producing hydrogen sulfide (H(2)S) and implicated in halitosis. RESULTS In laboratory tests, a significant dose-dependent effect was observed with Actinomyces viscosus as a model system using the Alamar blue procedure (P < 0.05). Clinical studies examined the effects 1.5 h and 3 h post-treatment on salivary bacteria and bacteria producing H(2)S. The first study compared the control rinse with the 0.03% and 0.06% chlorhexidine rinses; a second study compared the effects of the control rinse and the 0.06% and 0.12% chlorhexidine mouthrinses. In both studies, chlorhexidine rinses demonstrated significant dose-dependent effects post-treatment on salivary bacteria vs. the control rinse (P < 0.05). Significant decreases in H(2)S-producing bacteria were noted with these chlorhexidine rinses vs. the control rinse (P < 0.05). CONCLUSION The results highlight the dose-dependent relationships noted in laboratory and clinical tests which have potential implications for the use of lower doses of chlorhexidine to inhibit oral bacteria, including those implicated in halitosis.
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