title: Dental units: an environmental study of sources of potentially pathogenic mycobacteria.
abstract: METHODS
  Infections caused by non-tuberculous mycobacteria (NTM) are generally thought to be acquired from environmental sources. However, little is known about the situations in which transmission occurs.
  
  
  OBJECTIVE
  In an attempt to identify situations of relevant contact with NTM we investigated the water to which patients are exposed during dental treatment.
  
  
  METHODS
  The concentration and species of NTM were determined in 43 cooling and spray water samples from 21 dental units in ten offices. In addition, mycobacterial colonization of 16 biofilm samples from the waterlines of two dental units was investigated.
  
  
  RESULTS
  The mean NTM concentration in the water samples was 365 colony-forming units (cfu) per mL, exceeding the mean drinking water concentration by a factor of almost 400. In the biofilm samples the mean NTM density amounted to 1165 cfu/cm2. The species identified included Mycobacterium gordonae, M. flavescens, M. chelonae, 'M. chelonae-like organism' and M. simiae.
  
  
  CONCLUSIONS
  High numbers of NTM may be swallowed, inhaled or inoculated into oral wounds during dental treatment, possibly resulting in colonization, sensitization or infection. Mycobacterial proliferation in biofilms forming within dental units may explain the extent of NTM contamination of dental spray and cooling water.
authors.affiliation: Hygiene-Institut der Universität Bonn, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Schulze-Röbbecke
authors.forename: C
authors.initials: C
authors.lastname: Feldmann
authors.forename: R
authors.initials: R
authors.lastname: Fischeder
authors.forename: B
authors.initials: B
authors.lastname: Janning
authors.forename: M
authors.initials: M
authors.lastname: Exner
authors.forename: G
authors.initials: G
authors.lastname: Wahl
mesh_terms: D018441:Biofilms; D003428:Cross Infection / Q000635:transmission*; D003729:Dental Care / Q000009:adverse effects*; D006801:Humans; D009165:Mycobacterium Infections, Nontuberculous / Q000635:transmission*; D009170:Nontuberculous Mycobacteria / Q000145:classification / Q000254:growth & development / Q000302:isolation & purification*; D014871:Water Microbiology