Journal of Dentistry
Volume 35, Issue 9 , Pages 721-730 , September 2007

Microbial biofilm formation in DUWS and their control using disinfectants

  • J.T. Walker

      Affiliations

    • Centre for Emergency Preparedness and Response, HPA Porton Down, Salisbury SP4 0JG, United Kingdom
    • Corresponding Author InformationCorresponding author. Tel.: +44 1980 6122643; fax: +44 1980 612622.
    • ,
  • P.D. Marsh

      Affiliations

    • Centre for Emergency Preparedness and Response, HPA Porton Down, Salisbury SP4 0JG, United Kingdom
    • Leeds Dental Institute, Leeds LS2 9LU, United Kingdom

Received 23 May 2007 ,Revised 3 July 2007 ,Accepted 3 July 2007.

References 

  1. Depaola LG, Mangan D, Mills SE, et al. A review of the science regarding dental unit waterlines. Journal of American Dental Association. 2002;133:1199–1206
  2. Panagakos FS, Lassiter T, Kumar E. Dental unit waterlines: review and product evaluation. Journal of New Jersey Dental Association. 2001;72:20–25
  3. Pankhurst CL, Johnson NW, Woods RG. Microbial contamination of dental unit waterlines: the scientific argument. International Dental Journal. 1998;48:359–368
  4. Pederson ED, Stone ME, Ragain JC, Simecek JW. Waterline biofilm and the dental treatment facility: a review. General Dentistry. 2002;50:190–195
  5. Williams JF, Molinari JA, Andrews N. Microbial contamination of dental unit waterlines: origins and characteristics. Compendeum of Continual Education for Dentists. 1996;17:538–540
  6. Williams HN, Paszko-Kolva C, Shahamat M, Palmer C, Pettis C, Kelley J. Molecular techniques reveal high prevalence of Legionella in dental units. Journal of American Dental Association. 1996;127:1188–1193
  7. Barbeau J, Gauthier C, Payment P. Biofilms, infectious agents, and dental unit waterlines: a review. Canadian Journal of Microbiology. 1998;44:1019–1028
  8. Walker JT, Bradshaw DJ, Bennett AM, Fulford MR, Martin MV, Marsh PD. Microbial biofilm formation and contamination of dental-unit water systems in general dental practice. Applied and Environmental Microbiology. 2000;66:3363–3367
  9. Anonymous . Council Directive 98/83/EC of 3 November 1998 on the quality of water intended for human consumption. Official Journal of the European Community. 1998;L330:32–54
  10. Anonymous. National primary drinking water regulations: US Environmental Protection Agency; 2002. http://www.epa.gov/safewater/mcl.
  11. Anonymous . Infection control recommendations for the dental office and the dental laboratory. Journal of the American Dental Association. 1996;127:672–680
  12. Anonymous . Guidelines for infection control in dental health-care settings. MMWR Morb Mortal Wkly Rep. 2003;55:1–76
  13. Martin MV. The significance of the bacterial contamination of dental unit water systems. British Dental Journal. 1987;163:152–154
  14. Fotos P, Westfall H, Snyder I, Miler R, Mutchler B. Prevalence of legionella-specific IgG and IgM antibody in a dental clinic population. Journal of Dental Research. 1985;64:1382–1385
  15. Reinthaler FF, Mascher F, Stunzner D. Serological examinations for antibodies against Legionella species in dental personnel. Journal of Dental Research. 1988;67:942–943
  16. Pankhurst CL, Coulter W, Philpott-Howard JJ, et al. Prevalence of legionella waterline contamination and Legionella pneumophila antibodies in general dental practitioners in London and rural Northern Ireland. British Dental Journal. 2003;195:591–594
  17. Pankhurst CL, Coulter W, Philpott-Howard JN, Surman-Lee S, Warburton F, Challacombe S. Evaluation of the potential risk of occupational asthma in dentists exposed to contaminated dental unit waterlines. Primary Dent Care. 2005;12:53–59
  18. Bennett AM, Fulford MR, Walker JT, Bradshaw DJ, Martin MV, Marsh PD. Microbial aerosols in general dental practice. British Dental Journal. 2000;189:664–667
  19. Montagna MT, Tato D, Napoli C, et al. Pilot study on the presence of Legionella spp. in 6 Italian cities’ dental units. Annali D’Igiene. 2006;18:297–303
  20. Donlan RM. Biofilms: microbial life on surfaces. Emerging Infectious Diseases. 2002;8:881–890
  21. Beierle JW. Biofilms, an introduction. Journal of Californian Dental Association. 2001;29:347–350
  22. Stickler D. Biofilms. Current Opinions in Microbiology. 1999;2:270–275
  23. Costerton JW, Lewandowski Z, DeBeer D, Caldwell D, Korber D, James G. Biofilms, the customized microniche. Journal of Bacteriology. 1994;176:2137–2142
  24. Wong AC. Biofilms in food processing environments. Journal of Dairy Science. 1998;81:2765–2770
  25. Stroes-Gascoyne S, West JM. Microbial studies in the Canadian nuclear fuel waste management program. FEMS Microbiological Reviews. 1997;20:573–590
  26. Beveridge TJ, Makin SA, Kadurugamuwa JL, Li Z. Interactions between biofilms and the environment. FEMS Microbiological Reviews. 1997;20:291–303
  27. Deshusses MA. Biological waste air treatment in biofilters. Current Opinion in Biotechnology. 1997;8:335–339
  28. McMath SM, Sumpter C, Holt DM, Delanoue A, Chamberlain AH. The fate of environmental coliforms in a model water distribution system. Letters in Applied Microbiology. 1999;28:93–97
  29. Darveau RP, Tanner A, Page RC. The microbial challenge in periodontitis. Periodontology 2000. 1997;14:12–32
  30. Merritt J, Anderson MH, Park NH, Shi W. Bacterial biofilm and dentistry. Journal of Californian Dental Association. 2001;29:355–360
  31. Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clinical and Microbiological Reviews. 2002;15:167–193
  32. Brading MG, Boyle J, Lappin-Scott H. Biofilm formation in laminar flow using Pseudomonas fluorescens EX101. Journal of Industrial Microbiology. 1995;15:297–304
  33. Fazio S, Uhlinger J, Parker J, White D. Estimates of uronic acids as quantitative measures of extracellular and cell wall polysaccharide polymers from environmental samples. Applied and Environmental Microbiology. 1982;43:1151–1159
  34. Thurman E. The Organic Geochemistry of Natural Waters. New York: Junk; 1985;
  35. Derjaquin B, Landau L. Theory of the stability of strongly charged lyophobic soils and of the adhesion of strongly charged particles in solutions of electrolytes. Acta Phsicoshimica. 1941;14:633–662
  36. Verwey E, Overbeek J. Theory of the stability lyophobic colloids. Amsterdam: Elsevier; 1948;
  37. Colbourne JS, Pratt DJ, Smith MG, Fisher-Hoch SP, Harper D. Water fittings as sources of Legionella pneumophila in a hospital plumbing system. Lancet. 1984;1:210–213
  38. Rowbotham TJ. Current views on the relationships between amoebae, legionellae and man. Israeli Journal of Medical Science. 1986;22:678–689
  39. Barbeau J, Buhler T. Biofilms augment the number of free-living amoebae in dental unit waterlines. Research in Microbiology. 2001;152:753–760
  40. Hughes G, North J, Walker JT, Sharp R. Biofilms, bacteriophage interactions and bacteriophage therapy. In: Gilbert P, Allison D., Brading, M, Verran J, Walker JT, editors. Bioline, pp. 325–32. Biofilm community interactions – chance or necessity? p. 325–32. Cardiff: BioLine; 2001.
  41. Schaule G, Griebe T, Flemming H-C. Steps in biofilm sampling and characterisation in biofouling cases. In:  Flemming H-C,  Szewyk U,  Griebe T editor. Biofilms – investigative methods an applications. Basel: Technomic; 2000;p. 1–22
  42. Roberts AP, Pratten J, Wilson M, Mullany P. Transfer of a conjugative transposon, Tn5397 in a model oral biofilm. FEMS Microbiological Letters. 1999;177:63–66
  43. Hausner M, Wuertz S. High rates of conjugation in bacterial biofilms as determined by quantitative in situ analysis. Applied and Environmental Microbiology. 1999;65:3710–3713
  44. Walker JT, Mackerness CW, Rogers J, Keevil CW. Biofilm – a haven for waterborne pathogens. In:  Lappin-Scott HM,  Costerton JW editor. Microbial biofilms. London: Cambridge University Press; 1995;p. 196–204
  45. Davies DG, Parsek MR, Pearson JP, Iglewski BH, Costerton JW, Greenberg EP. The involvement of cell-to-cell signals in the development of a bacterial biofilm. Science. 1998;280:295–298
  46. Gilbert P, Allison D. Biofilms and their resistance towards antimicrobial agents. In:  Newman HN,  Wilson M editor. Dental plaque revisited: oral biofilms in health and disease. Cardiff: Bioline; 2000;p. 125–143
  47. Anonymous  ADA Council on Scientific Affairs. Dental unit water lines: approaching the year 2000. Journal of the American Dental Association. 1999;130:1653–1664
  48. Anonymous. Infection control in dentistry: British Dental Association; 2002. A12. http://www.bda-dentistry.org.uk (accessed April 23, 2007).
  49. Lee TK, Waked EJ, Wolinsky LE, Mito RS, Danielson RE. Controlling biofilm and microbial contamination in dental unit waterlines. Journal of the Californian Dental Association. 2001;29:679–684
  50. Petti S, Tarsitani G. Detection and quantification of dental unit water line contamination by oral streptococci. Infection Control and Hospital Epidemiology. 2006;27:504–509
  51. Barbeau J, Tanguay R, Faucher E, et al. Multiparametric analysis of waterline contamination in dental units. Applied and Environmental Microbiology. 1996;62:3954–3959
  52. Williams JF, Johnston AM, Johnson B, Huntington MK, Mackenzie CD. Microbial contamination of dental unit waterlines: prevalence, intensity and microbiological characteristics. Journal of American Dental Association. 1993;124:59–65
  53. Williams HN, Johnson A, Kelley JI, et al. Bacterial contamination of the water supply in newly installed dental units. Quintessence International. 1995;26:331–337
  54. Wright JB, Ruseska I, Costerton JW. Decreased biocide susceptibility of adherent Legionella pneumophila. Journal of Applied Bacteriology. 1991;71:531–538
  55. Wirthlin MR, Marshall GJ. Evaluation of ultrasonic scaling unit waterline contamination after use of chlorine dioxide mouthrinse lavage. Journal of Periodontology. 2001;72:401–410
  56. Smith AJ, Bagg J, Hood J. Use of chlorine dioxide to disinfect dental unit waterlines. Journal of Hospital Infection. 2001;49:285–288
  57. Smith AJ, McHugh S, Aitken I, Hood J. Evaluation of the efficacy of Alpron disinfectant for dental unit water lines. British Dental Journal. 2002;193:593–596
  58. Tuttlebee CM, O’Donnell MJ, Keane CT, et al. Effective control of dental chair unit waterline biofilm and marked reduction of bacterial contamination of output water using two peroxide-based disinfectants. Journal of Hospital Infection. 2002;52:192–205
  59. Larsen T, Fiehn NE. The effect of Sterilex Ultra for disinfection of dental unit waterlines. International Dental Journal. 2003;53:249–254
  60. Montebugnoli L, Chersoni S, Prati C, Dolci G. A between-patient disinfection method to control water line contamination and biofilm inside dental units. Journal of Hospital Infection. 2004;56:297–304
  61. O’Donnell MJ, Tuttlebee CM, Falkiner FR, Coleman DC. Bacterial contamination of dental chair units in a modern dental hospital caused by leakage from suction system hoses containing extensive biofilm. Journal of Hospital Infection. 2005;59:348–360
  62. Schel AJ, Marsh PD, Bradshaw DJ, et al. Comparison of the efficacies of disinfectants to control microbial contamination in dental unit water systems in general dental practices across the European Union. Applied and Environmental Microbiology. 2006;72:1380–1387
  63. O’Donnell MJ, Shore AC, Coleman DC. 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. Journal of Dentistry. 2006;34:648–661
  64. O’Donnell MJ, Shore AC, Russell RJ, Coleman DC. Optimisation of the long-term efficacy of dental chair waterline disinfection by the identification and rectification of factors associated with waterline disinfection failure. Journal of Dentistry. 2007;35:438–451
  65. Montebugnoli L, Dolci G. A new chemical formulation for control of dental unit water line contamination: an in vitro and clinical study. British Medical Council for Oral Health. 2002;2:1
  66. Karpay RI, Plamondon TJ, Mills SE, Dove SB. Combining periodic and continuous sodium hypochlorite treatment to control biofilms in dental unit water systems. Journal of American Dental Association. 1999;130:957–965
  67. Linger JB, Molinari JA, Forbes WC, Farthing CF, Winget WJ. Evaluation of a hydrogen peroxide disinfectant for dental unit waterlines. Journal of the American Dental Association. 2001;132:1287–1291
  68. Puttaiah R, Waggoner M, Sherman L, Kim P, Cederberg R, Bryan W. Efficacy of citric acid on dental treatment water and waterline biofilms. Journal of Dental Research. 1998;77:851
  69. Zinkevich V, Beech IB, Tapper R, Bogdarina I. The effect of super-oxidized water on Escherichia coli. Journal of Hospital Infection. 2000;46:153–156
  70. Tanaka N, Fujisawa T, Daimon T, Fujiwara K, Yamamoto M, Abe T. The use of electrolyzed solutions for the cleaning and disinfecting of dialyzers. Artificial Organs. 2000;24:921–928
  71. Marais JT, Brozel VS. Electro-chemically activated water in dental unit water lines. British Dental Journal. 1999;187:154–158
  72. Martin MV, Gallagher MA. An investigation of the efficacy of super-oxidised (Optident/Sterilox) water for the disinfection of dental unit water lines. British Dental Journal. 2005;198:353–354
  73. Chate RA. An audit improves the quality of water within the dental unit water lines of three separate facilities of a United Kingdom NHS Trust. British Dental Journal. 2006;201:565–569
  74. Walker JT, Bradshaw DJ, Fulford MR, Marsh PD. Microbiological evaluation of a range of disinfectant products to control mixed species biofilm contamination in a laboratory model of a dental unit water system. Applied and Environmental Microbiology. 2003;69:3327–3423
  75. Ozcan M, Kulak Y, Kazazoglu E. The effect of disinfectant agents in eliminating the contamination of dental unit water. Journal of Oral Rehabilitation. 2003;30:290–294
  76. Kettering JD, Stephens JA, Munoz-Viveros CA, Naylor WP. Reducing bacterial counts in dental unit waterlines: tap water versus distilled water. Journal of Contemporary Dental Practice. 2002;3:1–9
  77. Meiller TF, Kelley JI, Baqui AA, DePaola LG. Laboratory evaluation of anti-biofilm agents for use in dental unit waterlines. Journal of Clinical Dentistry. 2001;12:97–103
  78. Kite P, Eastwood K, Sugden S, Percival SL. Use of in vivo-generated biofilms from hemodialysis catheters to test the efficacy of a novel antimicrobial catheter lock for biofilm eradication in vitro. Journal of Clinical Microbiology. 2004;42:3073–3076
  79. Shetty N, Srinivasan S, Holton J, Ridgway GL. Evaluation of microbicidal activity of a new disinfectant: Sterilox 2500 against Clostridium difficile spores, Helicobacter pylori, vancomycin resistant Enterococcus species, Candida albicans and several Mycobacterium species. Journal of Hospital Infection. 1999;41:101–105
  80. Williams HN, Kelley J, Folineo D, Williams GC, Hawley CL, Sibiski J. Assessing microbial contamination in clean water dental units and compliance with disinfection protocol. Journal of the American Dental Association. 1994;125:1205–1211
  81. Wagner D, Fischer W, Paradies HH. Copper deterioration in a water distribution system of a county hospital in Germany caused by microbial influenced corrosion – 2 Simulation of the corrosion process in two test rigs installed in this hospital. Werkstoffe und Korrosion. 1992;43:496–502
  82. Roberts HW, Karpay RI, Mills SE. Dental unit waterline antimicrobial agents effect on dentin bond strength. Journal of the American Dental Association. 2000;131:179–183
  83. Taylor-Hardy TL, Leonard RH, Mauriello SM, Swift EJ. Effect of dental unit waterline biocides on enamel bond strengths. General Dentistry. 2001;49:421–425
  84. Batchu H, Chou HN, Rakowski D, Fan PL. The effect of disinfectants and line cleaners on the release of mercury from amalgam. Journal of American Dental Association. 2006;137:1419–1425
  85. von Fraunhofer JA, Kelley JI, DePaola LG, Meiller TF. Effect of a dental unit waterline treatment solution on composite-dentin shear bond strengths. Journal of Clinical Dentistry. 2004;15:28–32
  86. Putnins EE, Di Giovanni D, Bhullar AS. Dental unit waterline contamination and its possible implications during periodontal surgery. Journal of Periodontology. 2001;72:393–400
  87. Anonymous . Dental unit waterlines, approaching the year 2000. Journal of American Dental Association. 2000;130:1653–1664
  88. Porter SR. Prions and dentistry. Journal of the Royal Society of Medicine. 2002;95:178–181
  89. Walker JT, Marsh PD. A review of biofilms and their role in microbial contamination of dental unit water systems (DUWS). International Biodeteroriaton and Biodegradation Journal. 2004;54:87–98
  90. Shepherd PA, Shojaei MA, Eleazer PD, Van Stewart A, Staat RH. Clearance of biofilms from dental unit waterlines through the use of hydroperoxide ion-phase transfer catalysts. Quintessence International. 2001;32:755–761
  91. Lin YS, Stout JE, Yu VL, Vidic RD. Disinfection of water distribution systems for Legionella. Seminars in Respiratory Infections. 1998;13:147–159
  92. Pankhurst CL, Philpott-Howard JN, Hewitt JH, Casewell MW. The efficacy of chlorination and filtration in the control and eradication of Legionella from dental chair water systems. Journal of Hospital Infection. 1990;16:9–18
  93. Al Shorman H, Nabaa LA, Coulter WA, Pankhurst CL, Lynch E. Management of dental unit water lines. Dental Update. 2002;29:292–298
  94. Mills SE, Lauderdale PW, Mayhew RB. Reduction of microbial contamination in dental units with povidone-iodine 10%. Journal of the American Dental Association. 1986;113:280–284

PII: S0300-5712(07)00132-7

doi: 10.1016/j.jdent.2007.07.005

Journal of Dentistry
Volume 35, Issue 9 , Pages 721-730 , September 2007

Article Tools

* Image Usage & Resolution