title: Dental unit waterlines: review and product evaluation.
abstract: Dental practitioners must be knowledgeable regarding microbial contamination and biofilm formation in dental unit waterlines. Education should stress the need for improvement in the quality of water delivered to patients during treatment. Manufacturers must also play an important role by providing training and education regarding the proper use and maintenance of their systems. Dental facilities, both public and private, need reliable methods to prevent the development of biofilms within DUWs. These methods must be economical and require minimal effort to use on the part of the dental staff. In order for the system to work efficiently, the effluent water that is produced must be compatible with dental materials and be potentially free from toxic or carcinogenic materials. There are numerous models of water filtration units and chemical flushes available to the dental practitioner. However, the Food and Drug Administration have not approved all products currently on the market. Our evaluation of Zerosil, a new waterline-cleaning product, indicates that it is very easy to use and is extremely effective in killing the commonly found microorganisms in dental unit waterlines, as well as eliminating existing biofilms. It is also economical and requires minimum staff time to keep the waterlines clean. Following the initial treatments during week one, the water emanating from the DUWs was free from any viable microorganisms. This effect was present the entire three weeks in which the waterlines were treated. The elimination of viable microorganisms continued into a fourth study week, even though no further treatment of the DUWs was performed. Although the manufacturer recommends weekly treatment of DUWs following the initial treatment regimen, this result indicates that the product has a longer lasting effect than previously thought. Finally, the product can be delivered through any of the commercially available reservoir/bottle water delivery systems. From our study, Zerosil appears to meet the demanding requirements of keeping dental unit waterlines clean. Based on the research that has been done thus far, no universal treatment protocol can be recommended. A combination of approaches may offer the best available assurance of high-quality dental treatment water. Independent water reservoir systems, when used with a periodic chemical treatment protocol, have demonstrated safety and efficacy. Until we reach a point when a recommendation based on thorough evaluations can be made, dental offices should follow current ADA, OSAP, and CDC guidelines: flush waterlines for two to three minutes at the beginning of each day and for 20 to 30 seconds between each patient, and anti-retraction valves should be installed to prevent oral fluids from being drawn into dental waterlines. It is expected that in the near future, the dental practitioner will have a choice of proven systems and products to deal with this issue. Until that time, one should carefully evaluate any product or system being considered to prevent the formation of biofilms in DUWs.
authors.affiliation: New Jersey Dental School-University of Medicine and Dentistry of New Jersey, 110 Bergen Street, Newark, NJ 07103, USA. fpanagak@umdnj.edu
authors.forename: F S
authors.initials: FS
authors.lastname: Panagakos
authors.forename: T
authors.initials: T
authors.lastname: Lassiter
authors.forename: E
authors.initials: E
authors.lastname: Kumar
mesh_terms: D018441:Biofilms / Q000187:drug effects; D002176:Candida albicans / Q000187:drug effects; D015169:Colony Count, Microbial; D003748:Dental Equipment / Q000382:microbiology*; D004202:Disinfectants / Q000627:therapeutic use; D013293:Enterococcus faecalis / Q000187:drug effects; D004866:Equipment Contamination / Q000517:prevention & control*; D004867:Equipment Design; D004926:Escherichia coli / Q000187:drug effects; D006801:Humans; D019552:Infection Control, Dental; D007711:Klebsiella pneumoniae / Q000187:drug effects; D017410:Practice Guidelines as Topic; D011513:Proteus mirabilis / Q000187:drug effects; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D011786:Quality Control; D013211:Staphylococcus aureus / Q000187:drug effects; D014871:Water Microbiology; D018508:Water Purification / Q000295:instrumentation / Q000379:methods
chemical_list: D004202:Disinfectants