A novel automated waterline cleaning system that facilitates effective and consistent control of microbial biofilm contamination of dental chair unit waterlines: A one-year study

Abstract 

Microbial contamination of dental chair unit (DCU) output water caused by biofilm growth in dental unit waterlines (DUWs) is a universal problem and a potentially significant source of cross-infection. The microbial quality of output water from a Planmeca Compact i DCU equipped with the novel Water Management System (WMS), an integrated and automated DUW cleaning system, was investigated over a 12-month period with the hydrogen peroxide- and silver ion-containing disinfectants Planosil and Planosil Forte. Four weeks after connection to the potable-water quality mains supply the density of aerobic heterotrophic bacteria, rose from the low levels consistently found in the supply water throughout this study (mean average 77cfu/mL) to 15,400cfu/mL. Disinfection of DUWs once weekly with Planosil for 10 weeks resulted in a dramatic reduction in bacterial density immediately following disinfection (mean average 26cfu/mL). Bacterial density rose steadily between disinfections and by 7 days post-disinfection, water quality failed (mean average 384cfu/mL) the American Dental Association DCU water quality standard of ≤200cfu/mL. The DCU was then disinfected once weekly for 40 weeks with Planosil Forte. The average bacterial density immediately post-disinfection was 20cfu/mL and 7 days post-disinfection was 113cfu/mL. Electron microscopy showed that improved output water quality following disinfection with both disinfectants was associated with marked elimination of DUW biofilm, but deterioration of water quality following disinfection was associated with its regrowth. The most common bacterial species cultured from the mains water and the DCU output water were Microcococcus luteus and Sphingomonas spp., respectively, the latter of which are known opportunistic pathogens. The findings of this study show that the Planmeca Compact i DCU equipped with the easy to use and automated WMS, that requires minimal effort on the part of the operator, consistently provides output water that passes the ADA quality standard of ≤200cfu/mL for up to 7 days following once-weekly disinfection with Planosil Forte.

Keywords: Dental chair unit, Dental chair unit waterlines, Biofilm, Disinfection, Automated waterline disinfection, Hydrogen peroxide disinfectant, Environmental bacteria, Catalase positive bacteria