Dental Unit Waterlines: A Survey of Practices in Eastern France

Abstract

Water is essential during dental care. Physical and chemical techniques should be used to maintain a good water quality with respect to bacteria, and to ensure the safety of exposed patients and dental staff. The aim of this survey was to assess the modalities used by dental practitioners in Eastern France to maintain the water quality of their dental unit waterlines (DUWLs). A questionnaire about water quality maintenance practices was sent to 870 dental offices in 2016. The questionnaires were completed by 153 dental offices, covering about 223 dental care units. The majority of units were fed by mains water (91.0%), which is generally unfiltered (71.3%). One-third (33.6%) of the units had an independent water bottle reservoir. Flushing, a basic physical technique to improve the quality of units’ outflow water, was practiced in 65.4% of dental offices. Concerning the chemical treatment of water, it was used for 62.1% of the units. An analysis of the microbiological quality of the DUWL water was only carried out in 2.6% of the offices. In conclusion, providing better training to dental staff seems necessary to improve their practices and to generalize procedures that improve the microbiological quality of the water used.

Efficacy of BRS® and Alpron®/Bilpron® Disinfectants for Dental Unit Waterlines: A Six-Year Study

“…However, these human errors are possibly the cause of the only noncompliant result and of the 10 samples at alert level obtained during the six years of follow-up. Indeed, operator errors and inappropriately applied protocols can account for the inconsistent results of dental unit disinfection [14,46,47].…”

An Evaluation of Two Systems for the Management of the Microbiological Quality of Water in Dental Unit Waterlines: Hygowater® and IGN Calbénium®

“…Despite the presence of a specific sheet of traceability to follow the realization of regular flushing, which had been completed daily, there is no certainty that each purge lasted the recommended time. This is even more relevant as users were different each day because of university conditions, and as we know, the rigorous realization of flushing can be operator-dependent [6]. However, this statement is also true for the units connected to the Calbenium ® system.…”

“…Water flows through the dental unit waterlines (DUWL) to be brought to the site of interest, and unfortunately, microbial contamination of DUWL, via biofilms, is precisely well-described [1][2][3][4]. It is favored by the narrowness of the water tubing and the associated laminar flow at its periphery [5,6], the intermittent use of dental units [7], and the constituent material of DUWL [8]. This contamination can come either from the water supply network [9], or as a result of a back-contamination of DUWL.…”

“…Regarding its operating mode, which is described in the Material and Methods Section, our hypothesis was that it would be quickly effective and ensure a safe microbiological quality of the water in DUWL. The IGN Calbenium ® system is one of the most frequently distributed treatment systems by dental unit suppliers [1,6], has already been evaluated [1,4], and is therefore considered as a reference.…”

Chlorine-based DUWL disinfectant leads to a different microbial composition of water derived biofilms compared to H2O2-based chemical disinfectants in vitro

“…However, DUWL effluent water can still contain microbial loads above the safe water limit, as stated for the drinking water standard. This may be due to non-compliance with disinfection protocols ( Volgenant & Persoon, 2018 ; Baudet et al, 2019 ; Ji et al, 2019 ), but also due to tolerance of the remaining biofilm to the used disinfectants. Biofilm growth is a way for microorganisms to protect themselves from antimicrobial agents, by the structure of the biofilm itself and by changing is phenotype.…”