Dental Unit Waterline Contamination and Its Possible Implications During Periodontal Surgery

Abstract

The presence of high heterotrophic bacterial counts, sloughing biofilm, and high LPS levels are discussed in relation to patient risk and periodontal wound healing biology.

Assessment of Inhibitory Effects of Fluoride-Coated Tubes on Biofilm Formation by Using the In Vitro Dental Unit Waterline Biofilm Model

“…Increased risks of pyrogenic and septicemic complications have been reported when the level of contamination exceeds 10,000 bacteria/ml in dialysis fluids (11). Considering the total number of bacteria in DUWLs equipped with conventional polyurethane tubes (1,8,15,22,24,34,36,38) and the population determined in this study, the amount of S. paucimobilis discharged can be calculated to be greater than 10,000 CFU/ml. Although no information is available on the definitive concentration of S. paucimobilis that causes symptomatic infection, more attention should be paid to reduce its outflow from DUWLs to eliminate the risk of opportunistic infections.…”

“…Many studies demonstrated that the water discharged from DUWLs contains a number of bacteria (4,6,16,17,21,23,24,26,27,29,(32)(33)(34)(35)(36)(37), and pathogenic bacteria such as Legionella, which are virulent to an immunocompromised host, have been reported to be present occasionally (2,18,22). The bacterial outflow from DUWLs has been suggested to be caused by sloughing of bacteria from biofilms which had formed on the surfaces of the water supply tubes (16,23,(32)(33)(34).…”

Total viable counts, ATP, and endotoxin levels as potential markers of microbial contamination of dental unit water systems

“…Other workers have reported comparable endotoxin levels in DUWS and have attributed clinical significance to their findings. 11 However, endotoxin levels of up to 300 EU ml -1 have been found in the saliva of normal healthy subjects. 8 It is unlikely, therefore, that endotoxin concentrations of < 300 EU ml -1 will be of any clinical relevance.…”

First report of an acute purulent maxillary sinusitis caused by Pseudomonas aeruginosa secondary to dental implant placement in an immunocompetent patient

“…Numerous studies have shown that the problem of bacterial contamination of dental unit water lines (DUWLs) is widespread. [6][7][8][9][10] Microbial DUWLs contamination generally arises from municipal water piped into the dental unit, working handpieces of a unit, suck-back of patient saliva into the line, and the biofilm formed inside DUWLs. In particular, biofilms -sessile microbial communities exhibiting greater resistance to surfactants, biocides and antibiotics than their planktonic counterpart 10 -can constantly release bacteria, 11 thus providing a reservoir for continuous high-level contamination of DUWLs.…”

“…In particular, biofilms -sessile microbial communities exhibiting greater resistance to surfactants, biocides and antibiotics than their planktonic counterpart 10 -can constantly release bacteria, 11 thus providing a reservoir for continuous high-level contamination of DUWLs. 6,12,13 P. aeruginosa is the most frequent contaminant of DUWLs, being isolated in up to 50% of samples of dental unit water at concentrations of up to 2 × 10 5 CFU/ml. [13][14][15][16] This microorganism is able to thrive in low nutrient environments such as distilled water, often exhibits resistance to antibiotics and disinfectants such as chlorhexidine and iodophors, 17 and it is able to form biofilms in DUWLs, where it not only survives but proliferates waiting for susceptible hosts.…”