The effect of Sterilex Ultra for disinfection of dental unit waterlines

[Efficacy of Slightly Acidic Electrolyzed Water against Contamination of Water Line of Dental Units]

OBJECTIVES

The purpose of this study was to evaluate the efficacy of slightly acidic electrolyzed water (SAEW) against the contamination of the water line of dental units and the effects of SAEW on the water line.

MATERIALS AND METHODS

The experimental material was a prototype dental unit equipped with a SAEW generator. SAEW is directly supplied to each device or part of this unit system. Experimental SAEW samples were collected from a high-speed handpiece (HS-1), an ultrasonic scaler, and a cup filler of the prototype dental unit. Control samples were taken before and after the prescribed flushing from another high-speed handpiece (HS-2) that is directly supplied with tap water in the same dental unit. The samples were analyzed for free chlorine and heterotrophic bacteria for 7 years to assess the efficacy and effects of SAEW. The substances eluted in SAEW were examined to investigate the effect of SAEW on the water line. A questionnaire survey was conducted on patients on whom dental uints supplied with SAEW were used.

RESULTS

SAEW always showed a higher free chlorine concentration than tap water during the observation period of 7 years. In HS-2 supplied with tap water, the free chlorine concentration increased significantly owing to the prescribed flushing. SAEW always showed a significantly smaller number of heterotrophic bacteria than tap water. No abnormal levels values of water line components eluted into SAEW were observed. There were few negative comments from patients on whom dental units supplied with SAEW were used.

CONCLUSIONS

SAEW continuously used for 7 years was effective for contamination control in the water line of dental units.

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

Background/purpose

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

Materials and methods

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

Results

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

Conclusion

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

Effectiveness and safety of low-concentrated ozonized water for the reduction of contamination in dental unit water lines

Contamination of dental unit waterlines (DUWL) with heterotrophic bacteria can cause problems in immune compromised patients (aged, tumor and organ transplantation-patients). We focused on the use of low-concentrated ozonized water (OZW) as the biofilm formation restraint system for DUWL. Here, we examined the effects of low-concentrated OZW on the growth of bacteria and related biofilm formation and harmfulness to dental unit components (DUCs) in vitro.

OBJECTIVES

To evaluate the bactericidal effects of OZW on biofilms in DUWL and DUC in vitro.

METHODS

Low-concentrated OZW (0.4 mg/L) was generated using an OZS-PTDX generator. Heterotrophic bacterial biofilms in old DUWL tubes and Candia albicans solution (control microbe) were treated with OZW for 1 h with gentle agitation before static culturing for 96 h in Reasoner's 2A liquid media. The control solutions were 0.1% cetylpyridinium chloride (CPC), chlorinated tap water (TW), and phosphate-buffered saline (PBS). Adenosine triphosphate (ATP) amounts of the microbes were measured and the biofilms of these microbes were observed using scanning electron microscopy (SEM). Moreover, surfaces of DUC soaked in OZW and TW were observed by SEM.

RESULTS

The OZW reduced ATP levels in microbes to 50% compared to TW and PBS treatment, although CPC reduced it below detection limits. SEM observation revealed deformation of microbes cultured with OZW, whereas no changes were seen on DUC surfaces.

CONCLUSIONS

Low-concentrated OZW is bactericidal against heterotrophic bacteria biofilms and it is not harmful to DUC, suggesting that it might be useful in preventing DUWL contamination.

Efficacy of a Low Dose of Hydrogen Peroxide (Peroxy Ag⁺) for Continuous Treatment of Dental Unit Water Lines: Challenge Test with Legionella pneumophila Serogroup 1 in a Simulated Dental Unit Waterline

This study was designed to examine the in vitro bactericidal activity of hydrogen peroxide against Legionella. We tested hydrogen peroxide (Peroxy Ag⁺) at 600 ppm to evaluate Legionella survival in a simulated dental treatment water system equipped with Water Hygienization Equipment (W.H.E.) device that was artificially contaminated. When Legionella pneumophila serogroup (sg) 1 was exposed to Peroxy Ag⁺ for 60 min we obtained a two decimal log reduction. High antimicrobial efficacy was obtained with extended periods of exposure: four decimal log reduction at 75 min and five decimal log reduction at 15 h of exposure. Involving a simulation device (Peroxy Ag⁺ is flushed into the simulation dental unit waterlines (DUWL)) we obtained an average reduction of 85% of Legionella load. The product is effective in reducing the number of Legionella cells after 75 min of contact time (99.997%) in the simulator device under test conditions. The Peroxy Ag⁺ treatment is safe for continuous use in the dental water supply system (i.e., it is safe for patient contact), so it could be used as a preventive option, and it may be useful in long-term treatments, alone or coupled with a daily or periodic shock treatment.

Management of dental unit waterline biofilms in the 21st century

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.

Evaluation of gram negative bacterial contamination in dental unit water supplies in a university clinic in tabriz, iran

Background and aims

Bacterial contamination of dental unit water supplies (DUWS) has attracted a lot of attention in recent years due to the emergence of serious infectionsin susceptible dental patients. The aim of the present study was to evaluate the presence of gram-negative bacterial contamination in DUWS at Tabriz University of Medical Sciences Faculty of Dentistry.

Materials and methods

This descriptive study was carried out on 51 active dental units in different departments. Con-tamination was determined by taking samples from the unit's water supply before dental procedures and the use of specific culture media. The cultures were evaluated after 48 hours.

Results

Gram-negative bacterial contamination was identical in all the departments. In the departments on the ground floor, namely Departments of Periodontics and Oral and Maxillofacial Surgery, Pseudomonas contamination was observed in 71% of units; in the departments on the first floor, namely Departments of Prosthodontics, Orthodontics and Pedodon-tics, 46.8% of the units had Pseudomonas contamination; and in the departments on the second floor, namely Departments of Operative Dentistry and Endodontics, 37.7% of the units demonstrated Pseudomonas contamination.

Conclusion

Gram-negative bacterial contamination was evident in the evaluated DUWS. The contamination type was identical but the number of contaminated units decreased with the increase in the height of the floors.

Microbial biofilm formation in DUWS and their control using disinfectants

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.

Comparison of the efficacies of disinfectants to control microbial contamination in dental unit water systems in general dental practices across the European Union

Water delivered by dental unit water systems (DUWS) in general dental practices can harbor high numbers of bacteria, including opportunistic pathogens. Biofilms on tubing within DUWS provide a reservoir for microorganisms and should be controlled. This study compared disinfection products for their ability to meet the American Dental Association's guideline of <200 CFU x ml(-1) for DUWS water. Alpron, BioBlue, Dentosept, Oxygenal, Sanosil, Sterilex Ultra, and Ster4Spray were tested in DUWS (n = 134) in Denmark, Germany, Greece, Ireland, The Netherlands, Spain, and the United Kingdom. Weekly water samples were tested for total viable counts (TVCs) on yeast extract agar, and, where possible, the effects of products on established biofilm (TVCs) were measured. A 4- to 5-week baseline measurement period was followed by 6 to 8 weeks of disinfection (intermittent or continuous product application). DUWS water TVCs before disinfection ranged from 0 to 5.41 log CFU x ml(-1). Disinfectants achieved reductions in the median water TVC ranging from 0.69 (Ster4Spray) to 3.11 (Dentosept) log CFU x ml(-1), although occasional high values (up to 4.88 log CFU x ml(-1)) occurred with all products. Before treatment, 64% of all baseline samples exceeded American Dental Association guidelines, compared to only 17% following commencement of treatment; where tested, biofilm TVCs were reduced to below detectable levels. The antimicrobial efficacies of products varied (e.g., 91% of water samples from DUWS treated with Dentosept or Oxygenal met American Dental Association guidelines, compared to 60% of those treated with Ster4Spray). Overall, the continuously applied products performed better than those applied intermittently. The most effective products were Dentosept and Oxygenal, although Dentosept gave the most consistent and sustained antimicrobial effect over time.