title: Combining periodic and continuous sodium hypochlorite treatment to control biofilms in dental unit water systems.
abstract: BACKGROUND
  This study evaluated the efficacy of combined intermittent and continuous treatment with diluted sodium hypochlorite, or NaClO, to improve dental unit water quality in a clinical setting.
  
  
  METHODS
  In this prospective study, 10 dental units were fitted with separate water reservoir systems. Dental units were maintained with weekly rinses with 1:10 NaClO. Treatment water consisted of 750 milliliters of tap water and one drop of undiluted commercial bleach. Bacterial contamination in the effluent coolant water was assayed via microbiologic culture on a weekly basis. At the end of the study, scanning electron microscopy of the inner surfaces of the dental unit waterlines corroborated the results.
  
  
  RESULTS
  All 10 dental units consistently delivered water with less than 10 colony-forming units per milliliter, or CFU/mL, with a mean bacterial contamination of less than 1 CFU/mL. Baseline scanning electron microscopy demonstrated biofilm formation. Scanning electron microscopy at the end of the study demonstrated the lack of features consistent with biofilm formation. Although tri-halomethanes were detected in output water, all samples were below Environmental Protection Agency limits for drinking water.
  
  
  CONCLUSIONS
  Weekly treatment with 5.25 percent NaClO diluted 1:10, and concomitant use of chlorinated treatment water (3 parts per million chlorine) consistently attained the proposed American Dental Association goal of fewer than 200 CFU/mL in the unfiltered output. The effects of continuous treatment on dentin and enamel bond strength may require further evaluation.
  
  
  CONCLUSIONS
  The success of this protocol suggests that optimal attainment of dental water quality goals may require a combination of approaches.
authors.affiliation: Hillsborough Country Dental Research Clinic, Tampa, Fla. 33610, USA.
authors.forename: R I
authors.initials: RI
authors.lastname: Karpay
authors.forename: T J
authors.initials: TJ
authors.lastname: Plamondon
authors.forename: S E
authors.initials: SE
authors.lastname: Mills
authors.forename: S B
authors.initials: SB
authors.lastname: Dove
mesh_terms: D018441:Biofilms / Q000187:drug effects*; D005617:Chlorofluorocarbons, Methane / Q000032:analysis; D015169:Colony Count, Microbial; D019551:Dental Disinfectants / Q000737:chemistry / Q000494:pharmacology; D003748:Dental Equipment; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D008855:Microscopy, Electron, Scanning; D012973:Sodium Hypochlorite / Q000737:chemistry / Q000494:pharmacology; D014871:Water Microbiology; D014877:Water Pollution, Chemical; D018508:Water Purification / Q000295:instrumentation / Q000379:methods*
chemical_list: D005617:Chlorofluorocarbons, Methane; D019551:Dental Disinfectants; D012973:Sodium Hypochlorite