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VOLUME 13 , ISSUE 1 ( January-February, 2012 ) > List of Articles

ORIGINAL RESEARCH

Evaluation of an Automated Dental Unit Water System's Contamination Control Protocol

Raghunath Puttaiah, Kathy KH Svoboda, Shih Ming Lin, Lucio Montebugnoli, Giovanni Dolci, David Spratt, Jeff Siebert

Citation Information : Puttaiah R, Svoboda KK, Lin SM, Montebugnoli L, Dolci G, Spratt D, Siebert J. Evaluation of an Automated Dental Unit Water System's Contamination Control Protocol. J Contemp Dent Pract 2012; 13 (1):1-10.

DOI: 10.5005/jp-journals-10024-1087

Published Online: 01-08-2012

Copyright Statement:  Copyright © 2012; The Author(s).


Abstract

Background

This study addresses the efficacy of an automated decontamination protocol using the germicide ‘tetra acetyl ethylene diamine (TAED) perborate’ (Farmec SpA, Italy). The germicide TAED perborate protocol is used in the Castellini Dental Units fitted with an Autosteril unit (an automated device that can cycle 0.26% TAED perborate solution and sterile water for cleaning the water system between patients and overnight). Prior to testing the Autosteril and the 0.26% TAED perborate protocol on the Logos Jr Dental Unit (Castellini SpA, Italy), TAED perborate was used on a dental unit water system simulation device.

Methods

A dental unit water system simulation device equipped with four dental unit water systems and with naturally grown and mature biofilm contamination was used in this study (three treatment units and one control). One treatment group used a simulated 5 minutes contact with TAED perborate and sterile water for irrigation; the second used a simulated 5 minutes contact with TAED perborate and 2 ppm ClO2 for irrigation; the third used a simulated 5 minutes contact with TAED perborate and municipal water for irrigation. The control group used municipal water for irrigation with no cleaning/disinfection protocols. This protocol was repeated for 30 cycles. Laser scanning confocal microscopy (LSCM) was used to study the effects on natural and mature biofilms, and R2A agar used to quantify heterotrophic plate counts in the effluent irrigant. Antimicrobial efficacy was evaluated by challenging TAED perborate with microbes and spores (M. smegmatis and B. subtilis). Deleterious effects of the germicide were evaluated on metal and nonmetal parts of dental unit water systems. Heterotrophic plate counts using R2A agar and LSCM of the lines were conducted to assess biofilm and microbial control.

Results

Baseline water samples showed mean contamination >5.6 log10 cfu/ml. After initial cleaning, all three groups maintained mean contamination levels of less than 1.1 (SD <0.3) log10 cfu/ml. LSCM of baseline samples was positive for live biofilm in all groups. At the end of the study, viable biofilm was only present in the control. In the microbial challenge test, all vegetative organisms were killed within 30 seconds of contact, while spores were killed within 5 minutes. Corrosion was seen in metals used in US-manufactured dental unit materials, while not observed in those used in the Castellini Logos Jr dental unit.

Conclusion

In this study, the TAED perborate protocol was effective in biofilm control and control of dental treatment water contamination. Use of sterile water or 2 ppm ClO2 along with TAED treatment also controlled planktonic contamination effectively.

Clinical significance

Environmental biofilms contaminate dental unit water systems over time and affect the quality of dental treatment water. Contaminants include environmental biofilms, microbes, including gram-negative rods and endotoxins in high doses that are not of acceptable quality for treating patients. There are many germicidal protocols for treating this contamination and one such is the prescribed use of TAED perborate used in conjunction with sterile water for irrigation in the autosteril device, an integral component of the Castellini dental units for between patient decontamination of dental unit water systems. This study was conducted on an automated simulation dental unit water system to test the TAED perborate protocol's efficacy on naturally grown, mature environmental biofilms, it's efficacy on microbes and spores and it's effects on materials used in dental unit water systems. This translational research addresses both microbial control and material effects of TAED perborate in studying efficacy and possible deleterious effects and simulated use in dentistry. Currently, this antimicrobial use protocol is followed worldwide in the Castellini dental units that are used in day-to-day dental patient care.

How to cite this article

Puttaiah R, Svoboda KKH, Lin SM, Montebugnoli L, Dolci G, Spratt D, Siebert J. Evaluation of an Automated Dental Unit Water System's Contamination Control Protocol. J Contemp Dent Pract 2012;13(1):1-10.


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  1. Dental unit water contamination. J Can Dent Assoc 1996;62(6):492-95.
  2. Multiparametric analysis of waterline contamination in dental units. J Can Dent Assoc 2000;66:539-41.
  3. Assessing microbial contamination in clean water dental units and compliance with disinfection protocol. JADA 1994;125:1205-11.
  4. Dental unit waterline contamination and its possible implications during periodontal surgery. J Periodontol 2001;72(3):93-400.
  5. Decontamination of dental unit water system: A review of current recommendations. Br Dent J 1999;181:369-72.
  6. Microbial contamination of dental unit waterlines: Prevalence, intensity and microbiological characteristics. J Am Dent Assoc 1993;124:59-65.
  7. Longitudinal pilot study of the efficacy of different treatments on dental unit water systems. 1995 Conference on Pharmaceutical Science and Technology, in conjunction with the 26 Annual Meeting of the Fine Particle Society. 08/26/1995, Chicago, IL.
  8. A multi-group longitudinal study of dental unit waterline contamination. J Dent Res 1996;75:(Abstract # 3176), 414.
  9. Biofilm and the dental office. J Am Dent Assoc 1996;127(2):181-89.
  10. Bacterial biofilms in nature and disease. Ann Rev Microbiol 1987;41:435-64.
  11. Dental unit waterlines-curbing infectious midstream. AGD Impact 1993;21(10):6-12.
  12. Influence of biofilms on microbial contamination in dental unit water. J of Dent 1991;19(5):290-95.
  13. Bacterial contamination and disinfection of the dental handpiece and the water it delivers. Virginia Dent J 1976;53:14-23.
  14. The source, frequency and extent of bacterial contamination of dental unit water systems. Brit Dent J 1984;157(98):98-101.
  15. A possible means of inadvertent transmission of infection to dental patients. J Dent Res 1957;36:932-34.
  16. The incidence and control of bacterial infection in dental spray reservoirs. Brit Dent J 1963;115:413-16.
  17. Evaluation of an independent sterile water reservoir system for highspeed instrumentation. J Dent Res 1976;abstract #855: B275.
  18. Widespread Legionella pneumophila contamination of dental stations in a dental school without apparent human infection. Epidemiol and Infect 1987;99:159-66.
  19. The efficacy of chlorination and filtration in control and eradication of Legionella from dental chair water systems. J Hosp Infect 1990;16:9-18.
  20. Reduction of microbial contamination in dental units with povidone-iodine 10%. J Am Dent Assoc 1986;113:280-84.
  21. Biofilms augment the number of free-living amoebae in dental unit waterlines. Res Microbiol 2001;152:753-60.
  22. Hospital infection by pseudomonas cepacia, letters to the editor. Lancet 1971;17:798.
  23. Acute bacterial endocarditis caused by a variant of the genus Herrella. Amer J Clin Path 1953;23:134.
  24. Wound infection with pseudomonas multivaorans—A water-borne contamination of disinfectant solutions. Letters to the editor. Lancet 1970;6:1188.
  25. Colonization of dental units by water bacteria. Brit Dent J 1973;135(5):189-90.
  26. Flavobacterium as a cause of bacterial endocarditis. Ann of Intern Med 1961;55:499-506.
  27. Isolation of an unusual fungus in treated dental unit waterlines. J Am Dent Assoc 2003;134(7):853-58.
  28. Mycobacterium chelonae infection among patients receiving high-flux dialysis in a hemodialysis clinic in California. J Infect Dis 1990;161:85-90.
  29. Disseminated infection with mycobacterium gordonae: Report of a case and critical review of the literature. Clin Infect Dis 1992;14:1229-39.
  30. Clinical roentgenographic features of nosocomial pulmonary disease due to mycobacterium xenopi. Am Rev Resp Dis 1981;123:104-09.
  31. Mycobacterium chelonae causing otitis media in an ear-nose-and-throat practice. N Engl J Med 1988;319:978-82.
  32. Prevalence of legionella-specific IgG and IgM antibody in a dental clinic population. J Dent Res 1985;64(12):1382-85.
  33. Serological examination for antibodies against Legionella species in dental personnel. J Dent Res 1988;67:942-43.
  34. Legionella contamination of dental unit waters. Appl and Environ Microbiol 1995;61(4):1208-13.
  35. Assessment of endotoxins in dental unit treatment water. J Dent Res 1998;77:(Abstract # 1257): 263.
  36. Endotoxin level as a potential marker of concentration of gram-negative bacteria in water effluent from dental units and dental aerosols. Ann Agric Environ Med 2005;12:229-32.
  37. Research model addressing policy issues for the dental unit water system. 1995 Conference on Pharmaceutical Science and Technology, in conjunction with the 26 Annual Meeting of the Fine Particle Society. 08/26/1995, Chicago, IL.
  38. Failure of anti-retraction valves and the procedure for between patient flushing: A rationale for chemical control of dental unit waterline contamination. Am J Dent Aug 2005;18(4):270-74.
  39. Efficacy of anti-retraction devices in preventing bacterial contamination of dental unit water lines. Journal of Dentistry 2003;31:105-10.
  40. Decontamination of dental unit water systems: A review of current recommendations. Brit Dent J 1996;181:369-72.
  41. Effectiveness of two devices designed to prevent fluid retraction in a high-speed handpiece. J Prosthet Dent 2000;84:225-28.
  42. Infection control for the dental team. Copenhagen Munksgaard 1991;98-99.
  43. Handpiece and water-line decontamination and HIV transmission: A critique. Dent Update 1993;20:53-56.
  44. Recommended Infection Control Practices for Dentistry. MMWR 1993;42:No RR-8.
  45. Guidelines for Infection Control in Dental Health-Care Settings. MMWR 2003;52:No. RR-17.
  46. Efficacy of flushing dental units for different time periods. J Dent Res 1997;abstract # 3366,76:434.
  47. Bacterial contamination of dental handpieces. J Dent 1980;8:249-53.
  48. Evaluation of hydrogen peroxide for dental unit waterline contamination control. AADR 2003 Annual Scientific Session, San Antonio, Texas, USA.
  49. The incidence and control of bacterial infection in dental spray reservoirs. Brit Dent J 1963;115:413-20.
  50. Efficacy of a CHG irrigant in biofilm and planktonic contamination of dental unit water systems. Abstract presented, IADR 2000 Annual Scientific Session, Washington DC.
  51. Studies on dental aerobiology: IV. Bacterial contamination of water delivered by dental units. J Dent Res 1971;50:1567-69.
  52. Effect of bleach on mature biofilm in dental unit waterlines. International Association for Dental Research Annual Meeting, San Francisco, March 1996.
  53. A pilot study of two methods for control of dental unit biofilms. Quintessence International 2000;31:41-48.
  54. Dental unit waterline treatment with sodium hypochlorite and acetic acid. Microchemical Journal 1998;59:333-40.
  55. Effects of constantly present low-grade iodine on dental unit waterline biofilm and planktonic contamination. OSAP Annual Scientific Session, June 1999, Cincinnati OH.
  56. Disinfection of dental unit water lines using Listerine antiseptic. J Dent Res 1995;74:153.
  57. Reducing bacterial counts in dental unit waterlines: Tap water versus distilled water. J Contemp Dent Pract Aug 2002;(3)3:1-9.
  58. Efficacy of citric acid in controlling biofilms in dental unit waterlines. J Dent Res 1998;77 (special issue), abstractb #1759: 851.
  59. Efficacy of chlorhexidine in controlling biofilm contamination of dental unit waterlines. J Dent Res 1998;77 (special issue A), abstract #1255:262.
  60. Effects of two different source waters and cleaning dental unit water systems. J Dent Res 1997; abstract #2165, 76: 284.
  61. Recommendations and reports. MMWR December 19, 2003/52(RR17); 62-64. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a2.htm
  62. Pesticide Regulation (PR) Notice 94-4; US EPA Office of Pesticide Programs. http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocumentsUCM079098.
  63. Release of disinfection-byproducts during NaOCl use on contaminated dental unit water systems. Annual Meeting of the Organization for Safety and Asepsis Procedures, Providence, RI, abstract #9807; June 18-21, 1998.
  64. Efficacy of sterisil in the treatment of dental unit water lines. UAB Digital Collections: http://contentdm.mhsl.uab.edu/cdm/ref/collection/etd/id/891 (MS Thesis).
  65. Effects of iodine in microbial control of dental treatment water. J Contemp Dent Pract 2011;12(3):143-51.
  66. Pneumonia associated with a dental unit waterline. Lancet 2012;379:684.
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